Different Volumes of Local Anesthetics in Thoracolumbar Interfascial Plane Block

Cairo University (CU)

Status: Completed

Conditions: Postoperative Pain

Treatments: Drug: Bupivacaine Injection 20ml; Drug: Bupivacaine Injection 10ml; Procedure: Anesthetic Management; Procedure: Thoracolumbar interfascial plane block (TLIP)Technique

Study type: Interventional

Funder types: Other

Identifiers

NCT05276908

MD-307-2020

Details and patient eligibility

About

Ultrasound-guided thoracolumbar interfascial plane block (TLIP)was first described in 2015 by Hand et al which also target the dorsal rami of the thoracolumbar nerves as they pass through the paraspinal musculature(between the multifidus muscle (MF) and the longissimus muscle (LG)). The block was performed bilaterally at the level of L3 and they reported a reproducible area of anesthesia to pinprick in a mean (SD) area covering 137.4 (71.0) cm2 of the lower back (including the midline) after 20 minutes of the block. This procedure has subsequently been modified by Ueshima H et al in 2016 by targeting the injection in the plane between the longissimus and iliocostalis muscles (mTLIP) which helps avoiding the spread of local anesthetics to the ventral ramus and neuraxial space, thus, the modified TLIP block is considered to be a more refined version of the original TLIP block and safer and easier to perform.

There are limited number of studies investigating the analgesic efficacy of mTLIP block however, no previous study has demonstrated the ideal local anesthetic volume for this block in lumber spine surgery. Moreover, this technique is considered new regional anesthetic techniques and so both of them should be involved in further studies, on the other hand the comparison between both of them at the same study wasn't discussed before, and so we will proceed at this study.

Full description

The aim of this study is to compare the post-operative analgesic efficacy of two different volumes of local anesthetics in bilateral modified thoracolumbar interfascial plane block in lumbar spine surgeries.

Prospective randomized double blinded study The study will be conducted in Kasr Alainy hospital orthopedic surgical theater. Adult patients undergoing lumbar spine surgeries involving 1 up to 3 adjacent lumbar vertebrae (eg. laminectomy, discectomy ...). at Kasr Alainy hospital.

Enrollment: 80 patients

Sex: All

Ages: 18 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• ● Both gender

  • Type of surgery: lumbar spine surgeries involving 1 up to 3 adjacent lumbar vertebrae
  • Physical status ASA I, II.
  • Age 18 to 65 Years.
  • Body mass index (BMI): > 20 kg/m2 and < 35 kg/m2.

Exclusion criteria

• ● Patients on preoperative opioid regimen for more than 1 month.

  • Patients with history of previous surgical operations in the lumbar region.
  • Patients with spinal deformities (eg. Scoliosis.....).
  • Hypersensitivity to Bupivacaine.
  • Extensive Lumbar spine surgeries like large tumor excisions, scoliosis correction or more than 2 level spine fixations.
  • Patients with communication difficulties.
  • Lumbar spine operations that will be performed with the patient in any position other than the prone position.
  • Severe neurological compromise (severe muscle weakness such as foot drop or sphincter disorders such as urinary incontinence).

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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80 participants in 2 patient groups

mTLIP10

Experimental group

Description:

patients will receive single shot of bilateral modified thoracolumbar interfascial plane block at the mid-level of the operative intervention with 20 ml 0.25%bupivacaine (10 ml on each side).

Treatment:

Procedure: Anesthetic Management

Procedure: Thoracolumbar interfascial plane block (TLIP)Technique

Drug: Bupivacaine Injection 10ml

mTLIP20

Experimental group

Description:

patients will receive single shot of bilateral modified thoracolumbar interfascial plane block at the mid-level of the operative intervention with 40 ml 0.25%bupivacaine (20 ml on each side).

Treatment:

Procedure: Anesthetic Management

Drug: Bupivacaine Injection 20ml

Procedure: Thoracolumbar interfascial plane block (TLIP)Technique