Skip to main content
SpringerLink
Log in

Postoperative recovery scores and pain management: a comparison of modified thoracolumbar interfascial plane block and quadratus lumborum block for lumbar disc herniation

European Spine Journal Aims and scope Submit manuscript

Cite this article

Abstract

Purpose

In this prospective, randomized study, we aimed to compare the global recovery scores and postoperative pain management between US-guided mTLIP block versus QLB after lumbar spine surgery.

Methods

60 patients with ASA score I-II planned for microendoscopic discectomy under general anesthesia were included. We allocated the patients into two groups: the QLB group (n = 30) or the mTLIP group (n = 30). QLB and mTLIP was performed with 30 ml 0.25% bupivacaine in the groups. Paracetamol 1 g IV 3 × 1 was ordered to the patients at the postoperative period. If the NRS score was ≥ 4, 1 mg/kg tramadol IV was administered as rescue analgesia.

Results

There was a significant between-group difference in the mean global QoR-40 scores 24 h postsurgery. Both the static and dynamic NRS scores were significantly lower in the postoperative 1–16 h period in the mTLIP group. There was no significant between-group difference in the NRS scores 24 h postsurgery. There was no significant between-group difference in postoperative rescue analgesia consumption. However, the need for rescue analgesia was lower in the postoperative first 5 h in the mTLIP group, and survival probability was higher in the mTLIP group according to Kaplan–Meier survival analysis. There was no significant difference between the groups in the rate of adverse events.

Conclusion

mTLIP provided superior analgesia compared to posterior QLB. The QoR-40 scores in the mTLIP group were higher than those in the QLB group.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

The datasets of the study are available from the corresponding author on reasonable request.

References

  1. Kanno H, Aizawa T, Hahimoto K, Itoi E (2019) Minimally invasive discectomy for lumbar disc herniation: current concepts, surgical techniques, and outcomes. Int Orthop 43(4):917–922. https://doi.org/10.1007/s00264-018-4256-5

    Article  PubMed  Google Scholar 

  2. Li X, Han Y, Di Z, Cui J, Pan J, Yang M, Sun G, Tan J, Li L (2016) Percutaneous endoscopic lumbar discectomy for lumbar disc herniation. J Clin Neurosci 33:19–27. https://doi.org/10.1016/j.jocn.2016.01

    Article  PubMed  Google Scholar 

  3. Momin AA, Steinmetz MP (2020) Evolution of minimally invasive lumbar spine surgery. World Neurosurg 140:622–626. https://doi.org/10.1016/j.wneu.2020.05.071

    Article  PubMed  Google Scholar 

  4. Hand WR, Taylor JM, Harvey NR, Epperson TI, Gunselman RJ, Bolin ED, Whiteley J (2015) Thoracolumbar interfascial plane (TLIP) block: a pilot study in volunteers. Can J Anaesth 62(11):1196–1200. https://doi.org/10.1007/s12630-015-0431-y

    Article  PubMed  Google Scholar 

  5. Ahiskalioglu A, Yayik AM, Doymus O, Selvitopi K, Ahiskalioglu EO, Calikoglu C, Alici HA, Karaca O (2018) Efficacy of ultrasound-guided modified thoracolumbar interfascial plane block for postoperative analgesia after spinal surgery: a randomized-controlled trial. Can J Anaesth 65(5):603–604. https://doi.org/10.1007/s12630-018-1051-0

    Article  PubMed  Google Scholar 

  6. Ahiskalioglu A, Yayik AM, Alici HA (2017) Ultrasound-guided lateral thoracolumbar interfascial plane (TLIP) block: description of new modified technique. J Clin Anesth 40:62. https://doi.org/10.1016/j.jclinane.2017.04.015

    Article  PubMed  Google Scholar 

  7. Ahiskalioglu A, Alici HA, Selvitopi K, Yayik AM (2017) Ultrasonography-guided modified thoracolumbar interfascial plane block: a new approach. Can J Anaesth 64(7):775–776. https://doi.org/10.1007/s12630-017-0851-y

    Article  PubMed  Google Scholar 

  8. Blanco R, Ansari T, Girgis E (2015) Quadratus lumborum block for postoperative pain after caesarean section: a randomised controlled trial. Eur J Anaesthesiol 32(11):812–818. https://doi.org/10.1097/EJA.0000000000000299

    Article  PubMed  Google Scholar 

  9. Elsharkawy H, El-Boghdadly K, Barrington M (2019) Quadratus lumborum block: anatomical concepts, mechanisms, and techniques. Anesthesiology 130(2):322–335. https://doi.org/10.1097/ALN.0000000000002524

    Article  PubMed  Google Scholar 

  10. El-Boghdadly K, Elsharkawy H, Short A, Chin KJ (2016) Quadratus lumborum block nomenclature and anatomical considerations. Reg Anesth Pain Med 41(4):548–549. https://doi.org/10.1097/AAP.0000000000000411

    Article  PubMed  Google Scholar 

  11. Alver S, Bahadir C, Tahta AC, Cetinkal A, Gölboyu BE, Erdogan C, Ekinci M (2022) The efficacy of ultrasound-guided anterior quadratus lumborum block for pain management following lumbar spinal surgery: a randomized controlled trial. BMC Anesthesiol 22(1):394. https://doi.org/10.1186/s12871-022-01943-8.PMID:36536307

    Article  PubMed  PubMed Central  Google Scholar 

  12. Stark PA, Myles PS, Burke JA (2013) Development and psychometric evaluation of a postoperative quality of recovery score: the QoR-15. Anesthesiology 118(6):1332–1340. https://doi.org/10.1097/ALN.0b013e318289b84b

    Article  PubMed  Google Scholar 

  13. Myles PS, Williams DL, Hendrata M, Anderson H, Weeks AM (2000) Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10,811 patients. Br J Anaesth 84(1):6–10. https://doi.org/10.1093/oxfordjournals.bja.a013383

    Article  CAS  PubMed  Google Scholar 

  14. Myles PS, Weitkamp B, Jones K, Melick J, Hensen S (2000) Validity and reliability of a postoperative quality of recovery score: the QoR-40. Br J Anaesth 84(1):11–15. https://doi.org/10.1093/oxfordjournals.bja.a013366

    Article  CAS  PubMed  Google Scholar 

  15. Finnerty DT, McMahon A, McNamara JR, Hartigan SD, Griffin M, Buggy DJ (2020) Comparing erector spinae plane block with serratus anterior plane block for minimally invasive thoracic surgery: a randomised clinical trial. Br J Anaesth 125(5):802–810. https://doi.org/10.1016/j.bja.2020.06.020

    Article  CAS  PubMed  Google Scholar 

  16. Yun S, Jo Y, Sim S, Jeong K, Oh C, Kim B, Lee WY, Park S, Kim YH, Ko Y, Chung W, Hong B (2021) Comparison of continuous and single interscalene block for quality of recovery score following arthroscopic rotator cuff repair. J Orthop Surg (Hong Kong) 29(1):23094990211000144. https://doi.org/10.1177/23094990211000142

    Article  PubMed  Google Scholar 

  17. Tulgar S, Ahiskalioglu A, De Cassai A, Gurkan Y (2019) Efficacy of bilateral erector spinae plane block in the management of pain: current insights. J Pain Res 27(12):2597–2613. https://doi.org/10.2147/JPR.S182128

    Article  Google Scholar 

  18. Willard FH, Vleeming A, Schuenke MD, Danneels L, Schleip R (2012) The thoracolumbar fascia: anatomy, function and clinical considerations. J Anat 221(6):507–536. https://doi.org/10.1111/j.1469-7580.2012.01511.x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Çiftçi B, Ekinci M (2020) A prospective and randomized trial comparing modified and classical techniques of ultrasound-guided thoracolumbar interfascial plane block. Agri 32(4):186–192. https://doi.org/10.14744/agri.2020.72325

    Article  PubMed  Google Scholar 

  20. Ciftci B, Ekinci M, Celik EC, Yayik AM, Aydin ME, Ahiskalioglu A (2020) Ultrasound-guided erector spinae plane block versus modified-thoracolumbar interfascial plane block for lumbar discectomy surgery: a Randomized. Controlled Study World Neurosurg 144:e849–e855. https://doi.org/10.1016/j.wneu.2020.09.077

    Article  PubMed  Google Scholar 

  21. Ekinci M, Çiftçi B, Çelik EC, Yayık AM, Tahta A, Atalay YO (2020) A comparison of the ultrasound-guided modified-thoracolumbar interfascial plane block and wound infiltration for postoperative pain management in lumbar spinal surgery patients. Agri 32(3):140–146. https://doi.org/10.14744/agri.2019.97759

    Article  PubMed  Google Scholar 

  22. Hamilton DL (2021) Does thoracolumbar interfascial plane block provide more focused analgesia than erector spinae plane block in lumbar spine surgery?. J Neurosurg Anesthesiol 33(1):92–93. https://doi.org/10.1097/ANA.0000000000000643

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Not applicable.

Funding

The authors have no sources of funding to declare for this manuscript.

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Reanimation, Istanbul Medipol University, Bagcilar, 34040, Istanbul, Turkey

    Selcuk Alver, Bahadir Ciftci & Cem Erdogan

  2. Department of Anesthesiology and Reanimation, Development and Design Application and Research Center, Ataturk University School of Medicine, Erzurum, Turkey

    Erkan Cem Celik & Ali Ahiskalioglu

  3. Istanbul Medipol University, Istanbul, Turkey

    Maral Sargolzaeimoghaddam

  4. Department of Neurosurgery, Istanbul Medipol University, Istanbul, Turkey

    Ahmet Cetinkal

Authors
  1. Selcuk Alver
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bahadir Ciftci
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Erkan Cem Celik
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maral Sargolzaeimoghaddam
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ahmet Cetinkal
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Cem Erdogan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ali Ahiskalioglu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All of the authors (SA, BC, ECC, MS, AC, CE, AA) made substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data; they have been involved in drafting the manuscript or revising it critically for important intellectual content; have given final approval of the version to be published.

Corresponding author

Correspondence to Bahadir Ciftci.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest.

Ethical approval

This study has been approved by Istanbul Medipol University Ethics and Research Committee. (06.01.2022, Decision No. 37) The study was registered and recorded on ClinicalTrials.gov (NCT05217121).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Alver, S., Ciftci, B., Celik, E.C. et al. Postoperative recovery scores and pain management: a comparison of modified thoracolumbar interfascial plane block and quadratus lumborum block for lumbar disc herniation. Eur Spine J (2023). https://doi.org/10.1007/s00586-023-07812-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00586-023-07812-3

Keywords

search

Navigation