Comparison of the Effectiveness of Ultrasound-Guided Quadratus Lumborum 2 Block and Classic Thoracolumbar Interfacial Plane Block in the Management of Postoperative Analgesia After Lumbar Spinal Surgery

Objective: The aim of this study was to compare the efficacy of US-guided Classic TLIP block and Posterior QLB (QL2) block for postoperative analgesia management after LDH surgery. Our primary aim is to determine the 24-hour opioid requirement, and our secondary aim is to; compare postoperative pain scores (NRS), to evaluate side effects (allergic reaction, nausea, vomiting) associated with opioid use and complications that may occur due to block.

Content: Lumbar spinal surgery is one of the most common operations performed for the treatment of back and leg pain (1). Pain control is an important part of the treatment in these patients who may develop chronic pain. In patients undergoing surgery for lumbar disc herniation (LDH), severe pain may occur in the postoperative period, especially in the operation area, and this pain may become chronic (2). Effective postoperative pain control reduces complications such as hospital-acquired opioids are widely used analgesic agents. Parenteral opioids are preferred for the treatment of acute postoperative pain in most patients who have surgery. Although opioids are widely used in the treatment of acute postoperative pain. They may cause opioid-related adverse events (ORAE) such as nausea, vomiting, allergic reactions, sedation, and respiratory depression (3). In order to reduce the use of systemic opioids, regional anesthesia techniques may be preferred with the increase in the use of ultrasound (US) in daily anesthesia practice (4).

Quadratus lumborum block (QLB) performed under US guidance is an interfacial plane block defined by Blanco (5). This block is used in the management of analgesia after abdominal and lumbar surgery (5-9). Local anesthetic solution is injected around the quadratus lumborum muscle to block the thoracolumbar nerves. In posterior OLB (QL2) block, local anesthetic solution is injected from the posterior part of the muscle and spreads between the Quadratus lumborum and Erector spina muscles (6). Since it is performed under US guidance, it is an easy and reliable method with a low complication rate. and thromboembolism, as it provides early mobilization and early discharge.Thoracolumbar interfacial plane (TLIP) block is a regional analgesia technique performed under US guidance, which was defined by Hand et al. in 2015 (10). Ueshima et al. retrospectively demonstrated that this technique produces effective analgesia after lumbar laminoplasty.

reported in their study (11). In the classical technique, local anesthetic infiltration is performed between the Multifidus and Longissimus muscles in the 4th Lumbar (L4) vertebral region (10). There is no study in the literature comparing classical TLIP block and QL2 block.

In this study, it was aimed to compare the effectiveness of US-guided Classic TLIP block and Posterior QLB (QL2) block for postoperative analgesia management after LDH surgery. Our primary aim is to determine the 24-hour opioid requirement, and our secondary aim is to; to compare postoperative pain scores (NRS), to evaluate side effects (allergic reaction, nausea, vomiting) associated with opioid use and complications that may occur due to block Material and Method Sixty patients with ASA classification I-II, aged 18-65 years, scheduled for lumbar discectomy + laminectomy under general anesthesia will be included in this prospective, randomized study. Patients with a history of bleeding diathesis, taking anticoagulant therapy, allergic or sensitive to local anesthetic and opioid drugs, patients with infection in the area to be blocked, patients who have had previous lumbar surgery, patients using gabapentinoids or corticosteroids, patients who cannot use a patient-controlled anesthesia device, patients with suspected pregnancy , pregnant or lactating mothers and patients who do not accept the procedure will be excluded from the study.