Effect of TLIP block on analgesic needs in people undergoing spine surgery under general anesthesia

In people undergoing lumbar spinal surgery, the combination of thoracolumbar interfascial plane (TLIP) block and general anesthesia decreased both postoperative and intraoperative analgesic requirements, lowered intra-operative hemodynamic response to surgery, and attained good postsurgery pain control.

Spinal surgeries are usually linked with significant postsurgery pain that takes approximately three days to recede. For encouraging early mobilization and minimizing postsurgery noxious events, appropriate perioperative pain control is vital. The most commonly performed spinal surgical procedures are laminectomy, discectomy, and spinal fixation.

Extensive dissection of bones, tissues, and ligaments is often carried out during spinal surgeries, leading to a considerable degree of postsurgery severe pain. It is a significant challenge for doctors to adequately manage pain in such patients. This is because most of the patients have already been given ordinary analgesics and/or opioids for improving the preexistent chronic back pain.

The pain following spine surgery can arise from mechanical irritation, nerve compression, or postsurgery inflammatory processes. Also, it can be originated from distinct structures like ligaments, muscles, vertebrae, dural sleeves, discs, and capsules of the facet joint. Innervation of these pain generators is notably from dorsal rami of spinal nerves. For managing severe pain disorders, opioids are usually utilized as effective analgesics.

But, their widespread usage is limited due to their adverse effects like respiratory distress, vomiting, nausea, and acquired tolerance. The preemptive multimodal pain-relieving regimens that depend on the synergistic action of nonopioids administered in reduced doses have been utilized to enhance postsurgery pain control and minimize the intake of opioids. The protocols to decrease pain following lumbar surgery suggest the usage of regional anesthesia techniques for reducing opioid analgesic use to the minimum.

The interfascial plane block exhibits an immense potential to offer extended postsurgery analgesia and to decrease opioid intake and neuraxial-associated motor block to a minimum. In case of transversus abdominis plane (TAP) block, the local anesthetic agents target the ventral rami of the thoracolumbar nerves, thus offering anesthesia to anterior abdominal wall. The TLIP block was initially elucidated by Hand et al. This regional anesthetic technique is comparable to the TAP block but it targets the back.

During TLIP block, injection of local anesthetics is done into fascial plane lying between multifidus and longissimus muscles at level of the 3^rd lumbar vertebra. By targeting the posterior rami of the thoracolumbar spinal nerves, it helps to attain a reproducible area of anesthesia having a predictable spread. But, some studies have stated that the ultrasound-guided TLIP block can be utilized during lumbar spine surgery to offer good perioperative pain control.

RATIONALE BEHIND RESEARCH

Till now, none of the prior studies has explored the impact of TLIP block analgesia on perioperative hemodynamics. With the aim to enhance the quality of anesthesia and to minimize the need for perioperative analgesics, this randomized controlled double-blinded clinical trial was carried out.

OBJECTIVE

A study was performed to examine the pain-relieving effect of combination of general anesthesia and TLIP block versus general anesthesia alone in people scheduled for elective spinal surgery 

Study outcomes

• The major endpoint was postoperative analgesic consumption in the initial 24 hours.
• Pain scores, intraoperative additional need for analgesic agents, and time to the 1st  request of postsurgery analgesia were the secondary outcomes.