Thoracolumbar interfascial plane block and erector spinae plane block for postoperative analgesia in patients undergoing spine surgery

Dear Editor,
Regional anaesthesia prior to surgical intervention plays an important role in reducing post-operative pain and limiting opioid consumption. Ultrasound-guided interfascial plane blocks have gained popularity because they allow analgesia to be targeted to a specific anatomical region and provide effective pain control. In the United States, lumbar spine surgery is one of the most commonly performed procedures for pain relief in patients with low back and leg pain [1]. In recent years, the advent of the thoracolumbar interfascial plane block (TLIP) and the erector spinae plane block (ESPB) have been shown as effective interventions for pain control in patients undergoing lumbar spine surgery such as an hemilaminectomy. Additionally, the ESPB has even been utilized as the main anaes­thetic in some cases [2]. We describe a case of a patient who obtained profound postoperative analgesia with the use of these regional techniques. Additionally, there is growing evidence of prolonged post-operative analgesia with the addition of adjuncts such as dexamethasone and dexmedetomidine to fascial plane blocks [3, 4]. We report one of the first successful uses of this technique for TLIP and ESPB. Patient consent was obtained for publishing this case report.
Our patient is a 39-year-old female who presented with right-sided leg pain and lumbar radiculopathy. She reported pain as 6/10 on a numerical rating scale. A lumbar computed tomography scan for the patient was unremarkable. Lumbar magnetic resonance imaging showed L5 disc herniation on the right paracentral position resulting in compression of the S1 nerve root and possible pseudoarthrosis of the L4 and L5 spinous process with bony ossifications posteriorly. Prior to imaging, the patient received physical therapy, epidural steroid injections, and medication management, all of which provided minimal relief. Hemilaminectomy, which involves removing laminae on a vertebra to relieve pressure on the spinal nerves, was conducted on the L5 and S1 segments. Prior to surgical intervention, the patient received a thoracolumbar interfascial plane regional nerve block and a lumbar erector spinae plane block by a regional anaesthesiologist. For the procedure, 20 mL of 0.2% ropivacaine with 5 mg of preservative-free dexamethasone and 25 μg of dexmedetomidine was used in total for the blocks. This medication was divided equally for both blocks. The TLIP procedure was performed under ultrasound guidance...


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