Background and aims Thoraco-lumbar inter fascial plane (TLIP) block was first described by Hand et al in 2015. Local anesthetic was injected in the fascial plane between multifidus and longissimus muscle. The TLIP block targets dorsal rami of the thoraco-lumbar nerves. Clinical studies suggested that TLIP block could be used for analgesia after lumbar spine surgery. There is no data on anterior extension of local anesthetic after TLIP block.
Methods Case report
Results 55-year-old female patient with herniated disc in the lumbar spine at L4-L5 level was scheduled for transforaminal lumbar interbody fusion surgery. The patient had radicular pain on both sides with VAS of 5–6, straight leg raise (SLR) test of 30o on the left and 45o on the right side. TLIP block was done before general anesthesia. Total of 30 ml Ropivacaine 0.375% was injected bilaterally at level of L4. After block, VAS decreased to 2; SLR test was 70o on both sides. The patient reported a reduction of sensation at dermatomes from L3 to S1 at the back and lower limbs. One gram of Paracetamol and 30 mg of Ketorolac was given postoperatively followed by 2 tablets of Ultracet a day. The TLIP block lasted for 12 hours. At day 1 after surgery, VAS was 0 at rest and 4 during mobilization.
Conclusions Local anesthetic can spread anteriorly and block the ventral rami of lumbar nerves after injection at the fascial plane between multifidus and longissimus muscle. Anatomical and clinical studies are required to validate the observation.
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