Intertransverse process and modified thoracolumbar interfascial plane blocks compared with conventional analgesia in lumbar disc herniation surgery: a randomized controlled trial.

Abstract

Background: Lumbar disc herniation surgery is associated with considerable postoperative pain despite its minimally invasive nature. Regional fascial plane blocks may reduce opioid consumption and improve recovery as part of multimodal analgesia. This study compared the analgesic efficacy of ultrasound-guided intertransverse process (ITP) and modified thoracolumbar interfascial plane (mTLIP) blocks with conventional analgesia in patients undergoing lumbar disc herniation surgery.

Methods: In this prospective randomized controlled trial, 84 patients undergoing elective lumbar disc herniation surgery under general anesthesia were allocated to a Control group, an mTLIP group, or an ITP group (n = 28 each). The primary outcome was cumulative morphine consumption during the first 24 postoperative hours. Secondary outcomes included postoperative pain scores, Quality of Recovery-15 (QoR-15) scores, intraoperative remifentanil consumption, and adverse events.

Results: Twenty-four-hour morphine consumption was significantly higher in the Control group than in the mTLIP and ITP groups (28.79 ± 10.11 mg vs. 16.93 ± 10.11 mg and 12.86 ± 6.14 mg, respectively; both p < 0.001), with no difference between the block groups. Intraoperative remifentanil consumption was significantly lower in the ITP and mTLIP groups than in the Control group (p < 0.001 and p = 0.001, respectively). Resting pain scores were significantly lower in the ITP group than in the Control group throughout the postoperative period, while dynamic pain scores were lower at the PACU time point and at 6, 12, and 24 h. No significant differences in pain scores were observed between the mTLIP and Control groups or between the two block groups. QoR-15 scores at 24 h were significantly higher in the ITP group than in the Control group (137 [102-150] vs. 130 [60-147]; p = 0.010). No significant differences in postoperative nausea and vomiting were observed, and no block-related complications occurred.

Conclusions: Both ITP and mTLIP blocks reduced perioperative opioid requirements after lumbar disc herniation surgery, with no significant difference between the two blocks. Compared with conventional analgesia, the ITP block was additionally associated with lower postoperative pain scores and improved recovery quality. Both techniques appear to be safe, comparably effective, opioid-sparing components of multimodal analgesia.

Trial registration: ClinicalTrials.gov NCT06391541. Prospectively registered on April 26, 2024.