• truncal blocks
• acute pain
• postoperative pain

To the Editor,

Our regards to Jeff L. Xu and Victor Tseng for their suggestion on standardizing nomenclature of interfascial nerve blocks aimed to block dorsal rami of spinal nerves.1 Although they suggested the term paraspinal interfascial plane blocks for such interfascial nerve blocks,1 the term “paraspinal nerve block” has been used to describe an interfascial block (between the extrathoracic fascia and paraspinal muscles near the thoracic 3/4 spinous process) for thoracic surgery.2 Moreover, both the terms paraspinal nerve block and paraspinal block has been used to represent paravertebral block,3 4 whereas “paraspinal anesthetic block” has been used to represent needling and infiltration of local anesthetic (LA) agents along the spinal process, in the supraspinal and interspinal ligaments and paravertebral muscles.5 Such similar sounding names used for different nerve block techniques may create confusion. Moreover, “paraneuraxial nerve block (ParaNXB)” has been proposed to represent nerve blocks done “just outside of neuraxial region”.6

Thoracolumbar interfascial plane (TLIP) block was described in volunteers by William Hand and his colleagues in 2015.7 They described the deposition of LA agents in the fascial plane between multifidus (MF) muscle and the longissimus (LG) muscles at the level of third lumbar vertebra.7 They reported that the cutaneous distribution of sensory loss may be over only a restricted lumbar area.7 Ali Ahiskalioglu and colleagues described a modification of TLIP block in regards to the plane into which LA agent is deposited, needle direction and angle of introduction.8 Instead of the plane between MF and LG, they deposited the LA in between LG and iliocostalis (IC) muscles and termed it as modified thoracolumbar interfascial plane block.8 Hironobu Ueshima and Hiroshi Otake performed TLIP block at the level of second lumbar vertebra and referred to it as modified TLIP block.9 They suggested that it has a wider sensory loss and can be used for “lumbar vertebra surgery at the thoracolumbar region”.9 Later on the same year in which Ali Ahiskalioglu and colleagues published their modified TLIP block,8 Hironobu Ueshima and Hiroshi Otake also described the deposition of LA in the plane between LG and IC and termed it as lateral TLIP block.10 It is not known whether the direction and angle of insertion of the needle is similar to that reported by Ali Ahiskalioglu and colleagues. Thus, the same name has been used to represent two different block techniques and two names have been used to represent probably the same modification. Surprisingly, even after citing the work by Ali Ahiskalioglu and colleagues,8 the authors still have used the term lateral TLIP block.11 Though the description of “lateral TLIP block” was published after the publication of the modified TLIP block by Ali Ahiskalioglu and colleagues, it is still used in place of modified TLIP block.12 Thus, unlike suggested by Jeff L. Xu and Victor Tseng,13 instead of a systematic way of nomenclature based only on target muscle fascia, a systematic and standardized way to include the other modifications must also be incorporated.1

Of late, there has been a gradual increase in description of “new interfascial nerve block” techniques. Thus, instead of only the interfascial blocks probably aiming at blocking dorsal rami of spinal nerves, scholar and scholarly bodies must lay down guidelines for the nomenclature of any other interfascial nerve block as well. It will standardize the nomenclature of nerve block and their modification and also save us some confusion.