Thoracolumbar Interfascial Plane Block in Spinal Surgery: A Systematic Review with Meta-Analysis.

Abstract

As the thoracolumbar interfascial plane (TLIP) block may be a promising alternative in spinal surgery, there is a need for timely meta-analysis of this method's effectiveness in different medical outcomes. The meta-analysis of 6 randomized controlled studies on the application of TLIP block in spinal surgery was performed under the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. The primary outcome used for comparison was the mean difference (MD) of pain intensity scores at rest/in motion between patients receiving TLIP block and those receiving no block care. Our analysis favors TLIP block over no block (control group) for pain intensity at rest (MD with 95% confidence interval [CI] is -1.14 [-1.29, -0.99], P value <0.00001, I² = 99%) and pain intensity in motion (MD with 95% CI is -1.49 [-1.73, -1.24], P value <0.00001, I² = 99%) on postoperative day 1. Analysis also favors TLIP block in terms of cumulative fentanyl consumption on postoperative day 1 (MD is -166.64 mcg with 95% CI [-204.48, -128.80], P value <0.00001, I² = 89%), postoperative side effects (risk ratio with 95% CI is 0.63 [0.44, 0.91], P value = 0.01, I² = 0%), requests for supplementary/rescue analgesia (risk ratio with 95% CI is 0.36 [0.23, 0.49], P value <0.00001, I² = 0%). The results are statistically significant. The TLIP block reduces postoperative pain intensity, opioid consumption, side effects, and requests for rescue analgesia after spinal surgery more than the no-block alternative.