Thoracolumbar interfacial plane block associated with pain reduction, early discharge
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Length of stay was greatly reduced in patients who received spinal anesthesia and a thoracolumbar interfacial plane block with marcaine or liposomal bupivacaine during “awake” spine fusion surgery, a presenter said.
At the North American Spine Society Annual Meeting, which was held as a virtual meeting, Alok D. Sharan, MD, MHCDS, said the combination of “awake” spine fusion, spinal anesthesia and the thoracolumbar interfacial plane (TLIP) block he and his colleagues have used in 127 patients since 2017 resulted in “a tremendous reduction in pain scores.”
Opioid usage was also positively impacted, according to Sharan, who is director of spine and orthopedics at NJ Spine and Wellness.
“You can also see a dramatic reduction in the amount of opioids the patients were using for spinal fusion surgery, about a 76% reduction. But, more importantly, when we incorporated the TLIP block with Exparel [liposomal bupivacaine, Pacira Pharmaceuticals Inc.], we found there was this dramatic reduction in their length of stay to the point where now many patients are able to go home the same day after a single-level lumbar fusion, about a 40% reduction,” he said.
Currently, the hospital length of stay is 0.8 days among patients treated with this protocol, which Sharan attributes to how little pain the patients report having.
“About 50% of our patients are able to go home the same day,” he said.
When Sharan and colleagues tracked narcotic use among these patients, they found 70% no longer used narcotics at 1 week postoperatively. According to Sharan, the 30% of patients whose narcotic use persisted beyond 1 week postoperatively were typically patients who were narcotic-dependent preoperatively.
“The addition of the TLIP block has led to dramatic improvements in patient satisfaction along with decreased narcotic use and decreased length of stay. I think that overall the use of the combination of spinal anesthesia and TLIP block is going to represent the next advancement in minimally invasive spine surgery and help push these surgeries more to the outpatient arena,” Sharan said.
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Sharan AD. Importance of thoracolumbar fascial block in spine surgery. Presented during: Physiological modifications for cost effectiveness and enhanced recovery: Enhanced recovery after spine surgery (ERASS): at: North American Spine Society Annual Meeting; Oct. 6-9, 2020 (virtual meeting).
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