Tantri Aida Rosita, Sukmono Raden Besthadi, Lumban Tobing Singkat Dohar Apul, Natali Christella
Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.
Department of Orthopedic and Traumatology, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.
Anesth Pain Med. 2022 Apr 12;12(2):e122174. doi: 10.5812/aapm-122174. eCollection 2022 Apr.
Ultrasound (US)-guided classical and modified thoracolumbar interfascial plane (TLIP) blocks are often used to provide adequate analgesia after lumbar spinal surgery. Postoperative pro-inflammatory interleukin 6 (IL-6) blood concentrations after lumbar spine surgery are related to postoperative pain and inflammation.
The purpose of this prospective randomized parallel controlled study was to assess postoperative pain and serum levels of pro-inflammatory IL-6 after posterior lumbar decompression and stabilization surgery with a classical and modified technique of TLIP block.
This prospective randomized, single-blinded controlled pilot study was conducted on eight patients who will undergo posterior lumbar decompression and stabilization surgery. After obtaining the ethical approval and an informed consent, all subjects were randomly allocated into the classic TLIP group and the modified TLIP group. Following general anesthesia induction, 20 mL bupivacaine 0.25% was injected on each side in interfascialis plane between m. longissimus and m. iliocostalis in modified TLIP group and between m. multifidus and m. longissimus in classical TLIP group. Intraoperative hemodynamic (blood pressure and heart rate) and noxious stimulation response level (qNOX), postoperative IL-6 level, 24-hour morphine consumption, and numerical rating score were recorded and analyzed.
The median of IL-6 level was found to be lower in the modified TLIP group 12 hours postoperatively compared to classic TLIP (29.91 (8.56 - 87.61) vs. 46.87 (2.87 - 92.35)). The mean Numerical Rating Scale (NRS) in the modified TLIP block was comparable with the classic TLIP group, although it was lower than the classic TLIP group (2.75 ± 1.5 vs. 3.75 ± 1.7 at 6 hours and 3.5 ± 1.3 vs. 4 ± 1.6 12 hours postoperatively). However, there was no difference in intraoperative hemodynamic, Qnox value, and total postoperative morphine consumption between the two groups.
Our study showed that modified TLIP block resulted in lower IL-6 level and NRS 12 hours postoperatively compared to classical TLIP block. However, there were no differences in total postoperative morphine consumption between the two groups.
超声（US）引导下的经典和改良胸腰段筋膜间平面（TLIP）阻滞常用于腰椎手术后提供充分的镇痛。腰椎手术后促炎白细胞介素6（IL-6）的血药浓度与术后疼痛和炎症有关。
本前瞻性随机平行对照研究的目的是评估采用经典和改良技术的TLIP阻滞在腰椎后路减压和内固定手术后的术后疼痛和促炎IL-6的血清水平。
本前瞻性随机、单盲对照试验研究纳入了8例拟行腰椎后路减压和内固定手术的患者。在获得伦理批准并取得知情同意后，所有受试者被随机分为经典TLIP组和改良TLIP组。全身麻醉诱导后，改良TLIP组在最长肌和髂肋肌之间的筋膜间平面每侧注射20 mL 0.25%布比卡因，经典TLIP组在多裂肌和最长肌之间注射。记录并分析术中血流动力学指标（血压和心率）、伤害性刺激反应水平（qNOX）、术后IL-6水平、24小时吗啡消耗量及数字评分。
术后12小时，改良TLIP组IL-6水平中位数低于经典TLIP组（29.91（8.56 - 87.61）对46.87（2.87 - 92.35））。改良TLIP阻滞的平均数字评分量表（NRS）与经典TLIP组相当，尽管低于经典TLIP组（术后6小时为2.75±1.5对3.75±1.7，术后12小时为3.5±1.3对4±1.6）。然而，两组术中血流动力学、Qnox值及术后吗啡总消耗量无差异。
我们的研究表明，与经典TLIP阻滞相比，改良TLIP阻滞术后12小时IL-6水平和NRS更低。然而，两组术后吗啡总消耗量无差异。
