Comparison of TLIP Block and QIP Block for Postoperative Analgesia After Lumbar Spine Surgery

Официальное название

Comparison of the Efficacy of Classic Thoracolumbar Interfascial Plane (TLIP) Block and Quadratus Lumborum-Iliac Plane (QIP) Block for Postoperative Analgesia in Patients Undergoing Lumbar Vertebral Surgery: A Prospective Observational Study

Обзор

This study compares two regional anesthesia techniques used for pain control after lumbar spine surgery: the classic thoracolumbar interfascial plane (TLIP) block and the quadratus lumborum-iliac plane (QIP) block. Patients between 18 and 65 years of age who undergo elective lumbar discectomy (up to two spinal levels) will be observed based on which block their treating anesthesiologist chooses to use as part of routine clinical practice. No randomization or additional intervention beyond standard care will be performed. Researchers will record the total amount of opioid pain medication used in the first 24 hours after surgery, the time until the first request for pain medication, pain scores at several time points after surgery (0, 1, 2, 4, 8, 12, and 24 hours), and any side effects (such as nausea, vomiting, or sedation) or complications related to the block. The aim is to compare the effectiveness and safety of these two techniques in reducing pain and opioid use after lumbar spine surgery.

Подробное описание

Patients undergoing elective lumbar discectomy at up to two levels, ASA physical status I-II, aged 18-65 years, who receive either a classic TLIP block or a QIP block as part of routine clinical anesthesia practice will be included in this prospective observational study. The choice of block technique is determined solely by the treating anesthesiologist's routine practice, not by study allocation. Both blocks are performed under ultrasound guidance at the end of surgery, before emergence from anesthesia, using bilateral injections of 20 mL (40 mL total) of 0.25% bupivacaine. All patients receive standardized general anesthesia and a multimodal analgesic regimen (intravenous paracetamol, dexketoprofen, and tramadol as rescue analgesia for VAS ≥ 4). Outcomes recorded include total opioid consumption in the first 24 postoperative hours, time to first opioid request, VAS pain scores at PACU (0h), 1, 2, 4, 8, 12, and 24 hours, postoperative side effects (nausea, vomiting, pruritus, sedation, hypotension), and block-related complications (hematoma, local anesthetic systemic toxicity, infection).

Вмешательства

• Процедура Thoracolumbar Interfascial Plane (TLIP) Block of bupivacaine
  Ultrasound-guided injection of 20 mL bilaterally (40 mL total) of 0.25% bupivacaine into the fascial plane between the multifidus and longissimus muscles at the relevant lumbar level, performed at the end of surgery before emergence from anesthesia, as part of routine postoperative analgesia.
• Процедура Quadratus Lumborum-Iliac Plane (QIP) Block
  Ultrasound-guided injection of 20 mL bilaterally (40 mL total) of 0.25% bupivacaine into the interfascial plane between the erector spinae and quadratus lumborum muscles at the iliac crest level, performed at the end of surgery before emergence from anesthesia, as part of routine postoperative analgesia.

Первичные конечные точки

• Total Opioid Consumption in the First 24 Postoperative Hours [Срок оценки: 0 to 24 hours after surgery]

Вторичные конечные точки (4)

• Time to First Opioid Request [Срок оценки: Up to 24 hours after surgery]
• Postoperative Pain Score (Visual Analog Scale) [Срок оценки: 0, 1, 2, 4, 8, 12, and 24 hours after surgery]
• Incidence of Postoperative Side Effects [Срок оценки: Up to 24 hours after surgery]
• Incidence of Block-Related Complications [Срок оценки: Up to 24 hours after surgery]

Критерии участия

Критерии включения

• Aged 18-65 years
• ASA physical status I-II
• Undergoing elective lumbar discectomy at up to two spinal levels under general anesthesia
• Receiving classic TLIP block or QIP block for postoperative analgesia as part of routine clinical practice

Критерии исключения

• Hypersensitivity or allergy to study medications
• Coagulopathy
• Infection at the injection site
• Severe neurological deficit
• Chronic opioid use
• Advanced hepatic or renal failure
• Obesity (BMI >35 kg/m2)
• Pregnancy
• ASA physical status III-IV
• Mental retardation
• Inability to provide informed consent

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

Здоровые добровольцы: Нет

Дизайн исследования

Модель наблюдения

Когортное

Центры проведения

Turkey (Türkiye) · 1 центр

• Vezirköprü State Hospital — Vezirköprü

Публикации

• 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
• Hand WR, Taylor JM, Harvey NR, Epperson TI, Gunselman RJ, Bolin ED, Whiteley J. Thoracolumbar interfascial plane (TLIP) block: a pilot study in volunteers. Can J Anaesth. 2015 Nov;62(11):1196-200. doi: 10.1007/s12630-015-0431-y. Epub 2015 Jul 7. PMID 26149600
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• Humble SR, Dalton AJ, Li L. A systematic review of therapeutic interventions to reduce acute and chronic post-surgical pain after amputation, thoracotomy or mastectomy. Eur J Pain. 2015 Apr;19(4):451-65. doi: 10.1002/ejp.567. Epub 2014 Aug 4. PMID 25088289
• Dietz N, Sharma M, Adams S, Alhourani A, Ugiliweneza B, Wang D, Nuno M, Drazin D, Boakye M. Enhanced Recovery After Surgery (ERAS) for Spine Surgery: A Systematic Review. World Neurosurg. 2019 Oct;130:415-426. doi: 10.1016/j.wneu.2019.06.181. Epub 2019 Jul 2. PMID 31276851
• Bajwa SJ, Haldar R. Pain management following spinal surgeries: An appraisal of the available options. J Craniovertebr Junction Spine. 2015 Jul-Sep;6(3):105-10. doi: 10.4103/0974-8237.161589. PMID 26288544

Идентификаторы

NCT: NCT07750418 · OMU KAEK 2026/248

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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