Lumbar Disc Herniation, Postoperative Pain
Conditions
Keywords
Thoracolumbar Interfascial Plane Block, Quadratus Lumborum Block, Lumbar Discectomy, Postoperative Analgesia
Brief summary
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.
Detailed description
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).
Interventions
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.
PROCEDUREQuadratus 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.
Sponsors
Vezirköprü State Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* 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
Exclusion criteria
* 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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total Opioid Consumption in the First 24 Postoperative Hours | 0 to 24 hours after surgery | Cumulative amount of intravenous tramadol (mg) administered as rescue analgesia during the first 24 hours after surgery in each group. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to First Opioid Request | Up to 24 hours after surgery | Time elapsed from end of surgery to the first patient request for rescue opioid analgesia (VAS ≥ 4) |
| Postoperative Pain Score (Visual Analog Scale) | 0, 1, 2, 4, 8, 12, and 24 hours after surgery | Pain intensity measured using the Visual Analog Scale (VAS, 0 = no pain, 10 = worst imaginable pain) at PACU (0h) and at 1, 2, 4, 8, 12, and 24 hours after surgery. |
| Incidence of Postoperative Side Effects | Up to 24 hours after surgery | Number of patients experiencing nausea, vomiting, pruritus, sedation, or hypotension after surgery. |
| Incidence of Block-Related Complications | Up to 24 hours after surgery | Number of patients experiencing hematoma, local anesthetic systemic toxicity, or infection related to the block procedure. |
Countries
Turkey (Türkiye)
Contacts
CONTACTMEHMET YUSUF YILMAZ, MD
CONTACTBETUL YILMAZ, MD
PRINCIPAL_INVESTIGATORMEHMET YUSUF YILMAZ, MD
Vezirkopru State Hospital
Outcome results
None listed