Ammar Mona Ahmed, Taeimah Mohamed
Department of Anesthesia and Intensive Care, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Saudi J Anaesth. 2018 Oct-Dec;12(4):559-564. doi: 10.4103/sja.SJA_177_18.
Thoracolumbar interfascial plane (TLIP) block involves injection of local anesthetics between multifidus and longissimus muscles at the 3 lumbar vertebral level assuming that it can block the dorsal rami of thoracolumbar nerves.
The objective of this study was to evaluate the analgesic effects gained after performing TLIP block (analogous to the transversus abdominis plane [TAP] block, but intended for the back) in patients undergoing lumbar discectomy.
This was a prospective, randomized, double-blinded, controlled clinical trial. Computer-generated randomization numbers were used to allocate patients into two groups. A total of 102 patients scheduled for lumbar discectomy were considered eligible, of these 70 patients were randomly included in the analysis: 35 patients (control group) received the standard general anesthetic technique and 35 patients (TLIP group) received TLIP block with 20 ml mixture of 0.25% bupivacaine and 1% lidocaine on each side. The primary outcome was to compare the two groups with regard to pain scores, whereas the secondary outcomes included the time to first analgesic (TFA), 24-h morphine consumption, and side effects associated with morphine such as nausea, vomiting, and sedation.
TLIP group compared with the control group showed a significant reduction in the postoperative Visual Analog Scale for pain score both on rest and movement, with no statistically significant difference at 24 h during movement. TFA was significantly shorter in the control group compared to the TLIP group (82.00 ± 69.01 vs. 442.7 ± 126.47 min, < 0.001). TLIP group had lower cumulative morphine consumption than control group of statistically significant difference (9.7 ± 6.38 vs. 25.88 ± 5.17 mg, < 0.001). TLIP block group compared with the control group showed a significant reduction of nausea and a lower incidence of sedation.
TLIP block is an effective and safe method for postoperative analgesia after lumbar discectomy.
胸腰筋膜平面（TLIP）阻滞是在第3腰椎水平的多裂肌和最长肌之间注射局部麻醉药，假定其可阻滞胸腰神经的背支。
本研究的目的是评估在接受腰椎间盘切除术的患者中实施TLIP阻滞（类似于腹横肌平面[TAP]阻滞，但用于背部）后获得的镇痛效果。
这是一项前瞻性、随机、双盲、对照临床试验。使用计算机生成的随机数将患者分为两组。共有102例计划进行腰椎间盘切除术的患者被认为符合条件，其中70例患者被随机纳入分析：35例患者（对照组）接受标准全身麻醉技术，35例患者（TLIP组）每侧接受20 ml 0.25%布比卡因和1%利多卡因混合液的TLIP阻滞。主要结局是比较两组的疼痛评分，次要结局包括首次使用镇痛药的时间（TFA）、24小时吗啡消耗量以及与吗啡相关的副作用，如恶心、呕吐和镇静。
与对照组相比，TLIP组静息和活动时的术后视觉模拟疼痛评分均显著降低，活动时24小时无统计学显著差异。与TLIP组相比，对照组的TFA显著缩短（82.00±69.01对442.7±126.47分钟，<0.001）。TLIP组的累积吗啡消耗量低于对照组，有统计学显著差异（9.7±6.38对25.88±5.17 mg，<0.001）。与对照组相比，TLIP阻滞组的恶心显著减少，镇静发生率较低。
TLIP阻滞是腰椎间盘切除术后一种有效且安全的术后镇痛方法。
