Comparison of the effect of modified thoracolumbar interfascial plan block with lidocaine-ketamine infusion on postoperative pain, patient satisfaction and opioid consumption in lumbar spinal surgery

Comparison of the Effect of Modified Thoracolumbar Interfascial Plan Block with Lidocaine-Ketamine Infusion on Postoperative Pain, Patient Satisfaction and Opioid Consumption in Lumbar Spinal Surgery Lumbar spinal surgery is one of the most painful procedures. Pain after lumbar spinal surgery is multifactorial and a difficult problem to solve. Lidocaine-Ketamine infusions and mTLIP block have been used to provide postoperative analgesia in lumbar spinal surgery. In this study, we aimed to retrospectively compare the postoperative effects of mTLIP block and lidocaine-ketamine infusions for postoperative multimodal analgesia in patients undergoing elective lumbar spinal surgery. Patients who underwent elective lumbar spinal surgery under general anesthesia were retrospectively reviewed. Patients with ASA score≥III, patients who underwent revision lumbar surgery, patients with coagulopathy and anticoagulant drug users, patients with psychiatric diseases and communication difficulties, patients with BMI>35kg/m², patients with an operation time exceeding 3 hours, patients who refused to participate in the study and patients with missing data were excluded. The files and data of the remaining patients were analyzed in detail. The data of the patients were divided into two groups as Group M (n:40) mTLIP block group and Group LK (n:40) lidocaine-ketamine infusion group. Demographic data, postoperative NRS values at rest and motion, the first time they needed analgesia, complications, satisfaction with the procedures, total opioid consumption were recorded from the patients' files. Group M had lower NRS score (p<0.001), less opioid use (p<0,001) and higher patient satisfaction (p<0.001) than Group LK. In addition, as the level of surgery increased, the NRS score of the patients increased and patient satisfaction decreased. There were no procedure-related complications in both groups. mTLIP block is effective as a part of multimodal analgesia in lumbar spinal surgery. In this study, we suggest that mTLIP block is superior to lidocaine-ketamine infusion in terms of pain scores, need for additional analgesics and patient satisfaction. Keywords: Lidocaine, Lumbar spinal surgery, Ketamine, Modified Thoracolumbar Interfascial Plan Block, Postoperative analgesia.