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Ultrasound-guided modified thoracolumbar interfascial plane block is effective for pain management following multi-level lumbar spinal fusion surgery
| Content Provider | Semantic Scholar |
|---|---|
| Author | Ekinci, Mursel Çiftçi, Bahadır Atalay, Yunus Oktay |
| Copyright Year | 2019 |
| Abstract | To the Editor, The number of spinal surgeries that are performed has been increasing because of the rise in the incidences of spinal diseases. Surgery for lumbar spinal fusion causes severe pain postoperatively, and the mobilization and rehabilitation of patients are very important after surgery (Kim et al. 2016). However, rehabilitation processes may be negatively affected by postoperative pain (Pınar et al. 2017). Therefore, postoperative pain management is an important issue following multi-level spinal fusion surgery. The postoperative pain can be managed with a variety of regional anesthesia techniques. One of these techniques is ultrasound-guided thoracolumbar interfascial plane (TLIP) block. TLIP block targets the dorsal rami of the thoracolumbar nerves, and there are increasing reports about its efficacy in pain management following spinal surgeries (Hand et al. 2015; Ueshima et al. 2017; Ueshima and Otake 2017). We report here on a case involving successful pain management using modified TLIP (mTLIP) block following multi-level lumbar spinal fusion surgery. Written informed consent was obtained from the patient for the publication of this case report and accompanying images. A 60-year-old man, who weighed 80 kg and had an American Society of Anesthesiologists (ASA) physical status of 2 (arterial hypertension), underwent lumbar spinal fusion surgery at three levels (L1–4 vertebrae levels) (Fig. 1a, b). After applying standard ASA monitoring, anesthesia was induced and orotracheal intubation was performed using an 8.0-mm tracheal tube. The patient was placed in the prone position. Before beginning the surgery, we performed a mTLIP block bilaterally. The block was performed under aseptic conditions at the level of the L3 vertebrae using the GE Vivid Q® ultrasound device (Fig. 2a). A 12-MHz linear ultrasound probe was covered with a sterile sheath and placed in a vertical orientation. After visualizing the hyperechoic shadow of the spinous process as an anatomical guide point, the probe was moved forward to the lateral to visualize the longissimus and iliocostal muscles. Between these muscles, a 22gauge, 80-mm block needle was inserted in a medial-tolateral direction in the interfascial plane. Once the needle tip had been placed within the interfacial plane and after careful aspiration to rule out intravascular needle placement, 2 mL of saline was injected to confirm the proper injection site, and then a dose of 0.25% bupivacaine 20mL was injected in each side (total 40mL) (Fig. 2b). A dose of 800mg of ibuprofen IV was administrated intraoperatively 30min before the end of the surgery for multimodal postoperative analgesia. The operation was uneventful, and there was no complication during the surgery. The patient was extubated and transferred to the post-anesthesia care unit (PACU). At the PACU, the patient's visual analog score (VAS) was 3; therefore, no analgesic was administered. After a modified Aldrete score of ≥ 9, the patient was discharged from the PACU. A dose of 400mg ibuprofen was administrated routinely, every 8 h. The maximum VAS score that the patient experienced was 3 at rest, and he achieved mobilization within 24 h. The patient was |
| Starting Page | 1 |
| Ending Page | 3 |
| Page Count | 3 |
| File Format | PDF HTM / HTML |
| DOI | 10.1186/s42077-019-0046-6 |
| Volume Number | 11 |
| Alternate Webpage(s) | https://asja.springeropen.com/track/pdf/10.1186/s42077-019-0046-6 |
| Journal | Ain-Shams Journal of Anesthesiology |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
