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

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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.


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.


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.


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

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Data availability

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


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Authors and Affiliations



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.

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Correspondence to Bahadir Ciftci.

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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 (NCT05217121).

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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).

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