OBJECTIVE Aim of this study was to evaluate the efficacy in reducing post-operative pain and opioid analgesia of a novel inter-disciplinary strategy combining pre-operative Thoraco-Lumbar Interfascial Plane (TLIP) block and percutaneous/endoscopic TLIF surgery. Secondary aims were to determine the time to first postoperative ambulation and hospital length of stay.
METHODS In this retrospective review, 42 patients that underwent elective single-level percutaneous/endoscopic TLIF surgery between 2015 and 2021 were divided into two groups: TLIP Group with 17 patients that underwent TLIP block and Non-TLIP Group with 25 patients. Both groups received the same post-operative analgesia with morphine as patient-controlled rescue medication. Visual Analogic Scale (VAS) and Oswestry Disability Index(ODI) scores were evaluated. Statistical evaluation was performed with Student’s T test.
RESULTS In contrast to the Non-TLIP group, the TLIP group’s post-operative, mean VAS back scores as well as mean ODI significantly decreased from 6.6 to 3.3 (P<0.01) and 32.8 to 23.6 (P<0.01) at hospital discharge. No differences were found between both groups at one month. The overall mean follow-up was 29±18 [3-78] months. Non-TLIP Group patients were administered a median post-operative 24-hour morphine dose equivalent (MDE) of 23 [range, 8-31]mgr, while TLIP Group patients did not require opioid analgesia (P<0.01). TLIP Group patients started post-operative ambulation at a median of 4.1[range, 2.5-26]hours with a median hospital length of stay of 24[range, 20-48]hours (P=0.112).
CONCLUSIONS TLIP block significantly improves patient outcome at hospital discharge after TLIF surgery without post-operative administration of opioids. A prospective study is recommended to confirm our preliminary results.