mTLIP vs QIPB for Postoperative Analgesia in Lumbar Microdiscectomy Surgery

Официальное название

Comparison of Ultrasound-Guided Modified Thoracolumbar Interfascial Plane Block Versus Quadro-Iliac Plane Block for Postoperative Analgesia in Patients Undergoing Lumbar Microdiscectomy

Обзор

The aim of this prospective randomized clinical study is to compare the analgesic efficacy and side effects of modified thoracolumbar interfascial plane block and quadroiliac plane block applied preoperatively in patients undergoing lumbar microdiscectomy surgery.The study will include a total of 80 patients aged 18-65 years with ASA I-III, with 40 patients in each group( Group mTLIP and Group QIPB) undergoing lumbar microdiscectomy surgery. The primary objective of the study is to compare groups in terms of PCA opioid consumption during the 48-hour postoperative period. Secondary objectives are to compare groups in terms of QoR-15 recovery score, dynamic and static numerical rating scale scores, total rescue analgesic use, time to first request for rescue analgesia, length of hospital stay, block and opioid-related side effects and complications, and perioperative remifentanil infusion dose.

Подробное описание

Lumbar spine surgery is commonly associated with moderate to severe postoperative pain . Inadequate pain control may lead to delayed mobilisation, increased cardiopulmonary complications, and prolonged hospital stay.

Ultrasound-guided regional analgesia techniques, particularly fascial plane blocks, are increasingly used as part of multimodal analgesia in lumbar spine surgery. The thoracolumbar interfascial plane (TLIP) block is an established technique that provides effective analgesia and has been modified to improve its clinical application, resulting in the modified thoracolumbar interfascial plane (mTLIP) block. Previous studies have demonstrated the effectiveness of mTLIP for postoperative analgesia after lumbar spine surgeries.

The quadro-iliac plane block (QIPB) is a recently described ultrasound-guided fascial plane block. Early reports suggest that QIPB may provide effective analgesia in lumbar spine procedures; however, comparative evidence with established techniques remains limited.

This prospective randomized clinical trial aims to compare bilateral ultrasound-guided mTLIP and QIPB performed before the surgery in patients undergoing elective lumbar microdiscectomy surgery under general anesthesia, to evaluate whether QIPB can be considered a safe and effective alternative to mTLIP for postoperative analgesia.

Вмешательства

• Процедура Modified Thoracolumbar Interfascial Plane Block (mTLIP)
  This is a fascial plane block in which a local anesthetic is injected into the interfascial plane between the longissimus and iliocostalis muscles. Participants in this group will undergo bilateral modified thoracolumbar interfascial plane blocks (mTLIP) under ultrasound guidance prior to surgery. Under sterile conditions, with the patient in the prone position, the ultrasound probe will be placed in the parasagittal plane at the midpoint of the surgical incision, taking into account the lumbar
• Процедура Quadro-Iliac Plane Block (QIPB)
  This is a fascial plane block is a procedure in which local anesthetic is injected at the point where the quadratus lumborum muscle attaches to the iliac crest, allowing it to spread between the erector spinae and quadratus lumborum muscles. Participants in the QIPB Group will undergo bilateral quadrioliac plane blocks (QIPB) under ultrasound guidance prior to surgery. Under sterile conditions, with the patient in the prone position, a convex ultrasound probe will be placed at the point where th

Первичные конечные точки

• 1. Postoperative 48-Hour PCA Opioid Consumption [Срок оценки: Time Frame: Postoperative 0-8, 8-16, 16-24 24-48 hours intervals]

Вторичные конечные точки (7)

• QoR-15 Recovery Score [Срок оценки: Postoperative 24th and 48th hours]
• Dynamic and static Numeric Rating Scale scores [Срок оценки: 0, 2, 4, 8, 16, 24, and 48 hours postoperatively]
• Total rescue analgesic dose [Срок оценки: Time Frame: Postoperative 48 hours]
• Time of first request for rescue analgesia [Срок оценки: Time Frame: Postoperative 48 hours]
• Length of Hospital Stay [Срок оценки: the day of discharge from the hospital (assessed up to 10 days)]
• Block and Opioid-Related Adverse Effects and Complications [Срок оценки: Time Frame: Postoperative 48 hours]
• Perioperative Remifentanil infusion dose [Срок оценки: During surgery]

Критерии участия

Критерии включения

• Age between 18 and 65 years
• Classified as American Society of Anesthesiologists physical status I-III
• Scheduled for elective lumbar microdiscectomy surgery under general anesthesia
• Provision of written informed consent

Критерии исключения

• Use of anticoagulant medications or presence of bleeding diathesis
• Known allergy or hypersensitivity to local anesthetics or opioid drugs
• Infection at the planned block site
• Alcohol or drug dependence
• Cognitive impairment preventing reliable pain assessment
• Pregnancy or lactation
• History of previous lumbar spine surgery
• Diabetes mellitus
• Renal or hepatic insufficiency

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Двойное слепое

Основная цель

Лечение

Центры проведения

Turkey (Türkiye) · 1 центр

• Bursa City Hospital — Bursa

Публикации

• Turan EI, Aslan C, Berber K, Sarban O, Sahin AS. Efficacy of quadro-iliac plane block in single level lumbar discectomies: a case series for novel block. Minerva Anestesiol. 2024 Dec;90(12):1159-1160. doi: 10.23736/S0375-9393.24.18314-9. Epub 2024 Sep 11. No abstract available. PMID 39258831
• Ciftci B, Ekinci M. A prospective and randomized trial comparing modified and classical techniques of ultrasound-guided thoracolumbar interfascial plane block. Agri. 2020 Nov;32(4):186-192. doi: 10.14744/agri.2020.72325. PMID 33398870
• Turan EI, Sahin AS. Quadro-iliac plane block (QIPB) in lumbar stabilisation surgeries: A case series. Indian J Anaesth. 2025 Feb;69(2):244-245. doi: 10.4103/ija.ija_1077_24. Epub 2025 Jan 29. No abstract available. PMID 40160919
• Tulgar S, Ciftci B, Ahiskalioglu A, Bilal B, Sakul BU, Girit M, Akin T, Narayanan M, Alici HA. Ultrasound guided quadro-iliac plane block: another novel fascial plane block. Pain Med. 2024 May 3;25(6):370-373. doi: 10.1093/pm/pnae018. PMID 38459608
• Alver S, Ciftci B, Celik EC, Sargolzaeimoghaddam M, Cetinkal A, Erdogan C, Ahiskalioglu A. 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. 2024 Jan;33(1):118-125. doi: 10.1007/s00586-023-07812-3. Epub 2023 Jun 14. PMID 37314577

Идентификаторы

NCT: NCT07480278 · BursaCityHOS 5

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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