Modified thoracolumbar interfascial plane block versus epidural analgesia at closure for lumbar discectomy: a randomized prospective study

Abstract

Background & objective: The postoperative period of lumbar discectomy surgery usually involves a period of moderate to severe pain if adequate pain management is not practiced. Various pain controlling methods have been used other than oral and/or parenteral analgesic administration. We aimed to examine the effect of epidural analgesia at closure (EAC) versus modified thoracolumbar interfascial plane (mTLIP) block on postoperative opioid consumption in patients undergoing lumbar discectomy. Methodology: It was a randomized, prospective study involving sixty adult patients undergoing single-level lumbar discectomy. Patients were randomly assigned to two groups. mTLIP group (n=30) received ultrasound-guided bilateral mTLIP block with 20 ml of 0.25% bupivacaine. EAC group (n=30) received 20 ml of 0.25% bupivacaine to the epidural space by the surgical team at the closure stage of surgery. Postoperatively, analgesia was performed with intravenous tramadol with a patient-controlled analgesia (PCA) pump. Visual analog scale (VAS) scores, opioid consumption, rescue analgesia and side effects were recorded. Results: Groups had similar demographic measures. There was statistically no difference in terms of opioid consumption from zero to 4th hr and VAS scores in the 1-2 hrs postoperatively (p > 0.05) between groups. At 4-12 hrs and 12-24 postoperatively hrs intervals, total opioid consumption was significantly lower in Group mTLIP compared to Group EAC (p < 0.05). At the 4th, 8th, 12th, and 24th hrs VAS scores were lower in Group mTLIP compared to Group EAC (p < 0.05). Rescue analgesia usage was significantly higher in the Group EAC than in the Group mTLIP, e.g. 11/30 vs. 3/30 respectively (p = 0.015). Conclusion: Preoperative bilateral, ultrasound-guided modified thoracolumbar interfascial plane block offers more effective postoperative analgesia, thus reducing tramadol consumption as compared to epidural analgesia at closure after lumbar discectomy surgery. Key words: Thoracolumbar interfascial plane block; Epidural analgesia’; Lumbar discectomy; Postoperative pain; Ultrasound guidance Citation: Çelik EC, Ekinci M, Yayik AM, Ahiskalioglu A, Aydi ME, Karaavci NC. Modified thoracolumbar interfascial plane block versus epidural analgesia at closure for lumbar discectomy: a randomized prospective study. Anaesth. pain intensive care 2020;24(6):__ Abbreviations: EAC – Epidural analgesia at closure; TLIP – thoracolumbar interfascial plane; mTLIP – modified thoracolumbar interfascial plane