Comparison of Thoracolumbar Interfascial Plane-to-Skin Distances at Different Lumbar Levels and Positions Under Ultrasonography

Year 2024, Volume: 21 Issue: 3, 520 - 526

Recep Çiçek , Veli Fahri Pehlivan , Başak Pehlivan , Erdoğan Duran

https://doi.org/10.35440/hutfd.1581667

Abstract

Background: This study aimed to determine the optimal lumbar level and patient position for performing the thoracolumbar interfascial plane (TLIP) block by evaluating the distance between the thoracolumbar interfascial plane and the skin using ultrasound guidance. Additionally, we explored the influence of body mass index (BMI) on this distance.
Materials and Methods: Eighty patients aged 18 to 65 years undergoing upper lumbar region surgery were evaluated. The thoracolumbar interfascial plane-to-skin distance was measured at L1 and L3 levels in three po-sitions: sitting, lateral, and prone, using a high-frequency ultrasound probe. Measurements were conducted without needle insertion, ensuring clarity and accuracy. Patient demographics, including age and body mass index (BMI), were recorded and analyzed to assess their impact on these measurements.
Results: The thoracolumbar interfascial plane was significantly closer to the skin at the L1 level compared to L3 across all positions (p<0.01). Among the positions, the prone position provided the closest plane-to-skin dis-tance and the clearest ultrasound image, allowing better visualization of anatomical landmarks. Conversely, the sitting position produced the poorest image quality and was the least comfortable for patients. Furthermore, a moderate positive correlation was found between BMI and the thoracolumbar plane-to-skin
Conclusions: Our findings suggest that the L1 level and prone position are optimal for TLIP block application, offering clearer imaging and easier block administration. For obese patients, the prone position is particularly advantageous as it reduces the skin-to-plane distance, potentially minimizing procedural difficulty and compli-cation risks. These insights contribute to the optimization of TLIP block techniques, especially in patient popu-lations with higher BMI. Further studies are recommended to confirm these findings and expand clinical appli-cations.

Keywords

Thoracolumbar interfascial plane block (TLIP), Peripheral nerve block, Ultrasonography, Regional anesthesia

Ethical Statement

This study was approved by the Clinical Research Ethics Committee of Harran University Faculty of Medicine (Approval Date: April 10, 2023; Approval Number: 23.06.11).

Ultrasonografi Altında Farklı Lomber Seviyeler ve Pozisyonlarda Torakolomber İnterfasyal Plan ile Cilt Mesafelerinin Karşılaştırılması

Abstract

Amaç: Bu çalışmanın amacı, ultrason rehberliğinde torakolomber interfasyal düzlem ile cilt arasındaki mesafeyi değerlendirerek torakolomber interfasyal düzlem (TLIP) bloğunu gerçekleştirmek için optimum lomber seviyeyi ve hasta pozisyonunu belirlemektir. Ek olarak, vücut kitle indeksinin (VKİ) bu mesafe üzerindeki etkisini araştırdık.
Materyal ve Metod: Üst lomber bölge cerrahisi geçiren seksen hasta değerlendirildi. Torakolomber interfasyal düzlem-cilt mesafesi, yüksek frekanslı bir ultrason probu kullanılarak üç pozisyonda L1 ve L3 seviyelerinde ölçüldü: oturma, lateral ve yüzüstü. Ölçümler iğne girişi olmadan gerçekleştirildi, netlik ve doğruluk sağlandı. BMI dahil hasta demografileri kaydedildi ve bu ölçümler üzerindeki etkilerini değerlendirmek için analiz edildi.
Bulgular: Torakolomber interfasyal düzlem, tüm pozisyonlarda L3'e kıyasla L1 seviyesinde cilde önemli ölçüde daha yakındı (p<0,01). Pozisyonlar arasında, yüzüstü pozisyon en yakın düzlem-cilt mesafesini ve en net ultrason görüntüsünü sağladı ve anatomik dönüm noktalarının daha iyi görüntülenmesini sağladı. Tersine, oturma pozisyonu en kötü görüntü kalitesini üretti ve hastalar için en az konforlu olanıydı. Ayrıca, BMI ile torakolomber düzlem-cilt mesafesi arasında orta düzeyde pozitif bir korelasyon bulundu ve bu, artan BMI'nin incelenen tüm pozisyonlarda mesafeyi artırdığını gösterdi.
Sonuç: Bulgularımız, L1 seviyesinin ve yüzüstü pozisyonun TLIP blok uygulaması için en uygun olduğunu, daha net görüntüleme ve daha kolay blok uygulaması sağladığını göstermektedir. Obez hastalar için yüzüstü pozisyon, cilt-düzlem mesafesini azalttığı ve potansiyel olarak prosedürel zorluk ve komplikasyon risklerini en aza indirdiği için özellikle avantajlıdır. Bu içgörüler, özellikle daha yüksek BMI'li hasta popülasyonlarında TLIP blok tekniklerinin optimizasyonuna katkıda bulunur. Bu bulguları doğrulamak ve klinik uygulamaları genişletmek için daha fazla çalışma önerilmektedir.

Keywords

Torakolomber interfasiyal düzlem bloğu (TLIP), Periferik sinir bloğu, Ultrasonografi, Rejyonel anestezi

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