Background; The postoperative period of lumbar discectomy surgery involves a painful process. We aimed to examine the effect of epidural analgesia at closure (EAC) versus modified thoracolumbar interfascial plane (mTLIP) block on postoperative opioid consumption in patients undergoing lumbar discectomy.
Methodology; This was a randomized prospective study involving sixty adult patients undergoing single-level lumbar discectomy surgery. Patients were randomly assigned to two groups. mTLIP group (n=30) received ultrasound-guided bilateral mTLIP block with 20 ml of 0.25% bupivacaine. EAC group (n=30) received 20 ml 0.25% bupivacaine to the epidural space by the surgical team at the closure stage of surgery. Postoperative analgesia was performed intravenous patient-controlled analgesia with tramadol. Visual analog scale (VAS) scores, opioid consumption, rescue analgesia, and side effects were evaluated.
Results; Groups had similar demographic measures. There was no statistical difference in terms of opioid consumption 0th-4th hours interval and VAS scores in the 1-2 hours postoperatively (p > 0.05) between groups. At the 4-12 hours and 12-24, postoperatively hours intervals and total opioid consumption were significantly lower in Group mTLIP compared to Group EAC (p < 0.05). At the 4th, 8th, 12th, and 24th hours VAS scores were lower in Group mTLIP compared to Group EAC (p < 0.05). Rescue analgesia usage was significantly higher in the group EAC than in the group mTLIP (11/30 vs 3/30, respectively, p= 0.015)
Conclusion; The preoperative bilateral, ultrasound-guided mTLIP block reduces tramadol consumption and improves analgesia compared with the EAC after lumbar discectomy surgery.
Key words: Thoracolumbar interfascial plane block, epidural analgesia, lumbar discectomy, postoperative pain, ultrasound
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