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

Yıl 2024, Cilt: 21 Sayı: 3, 520 - 526

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

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

Öz

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.

Anahtar Kelimeler

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

Etik Beyan

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

• 1. Ahiskalioglu A, Alici HA, Selvitopi K, Yayik AM. Ultrasonog-raphy-guided modified thoracolumbar interfascial plane block: a new approach. Canadian Journal of Anesthe-sia/Journal canadien d’anesthésie. 2017;64(7):775–776.
• 2. Ahiskalioglu A, Yayik AM, Alici HA. Ultrasound-guided late-ral thoracolumbar interfascial plane (TLIP) block: Descrip-tion of new modified technique. Journal of Clinical Anesthe-sia. 2017;40:62.
• 3. Albrecht E, Chin KJ. Advances in regional anaesthesia and acute pain management: a narrative review. Anaesthesia. 2020;75(S1):e101–e110.
• 4. B Ç, Ekinci M. A prospective and randomized trial compa-ring modified and classical techniques of ultrasound-guided thoracolumbar interfascial plane block. Ağrı - The Journal of The Turkish Society of Algology. 2020;32(4):186–192.
• 5. Binici O, Buyukfirat E. Comparison of different arm positi-ons and angles with ultrasound for infraclavicular block. Annals of Medical Research. 2019;26(6):976–979.
• 6. Duran E, Kaya F, Pehlivan B, Pehlivan VF. Determination of the optimal position of the lower extremity for femoral nerve block with ultrasonographic measurements: a pros-pective volunteer-based study. European review for medical and pharmacological sciences. 2024;28(8):3066–3072.
• 7. GBD 2015 Obesity Collaborators; Afshin A, Forouzanfar MH, Reitsma MB, Sur P, Estep K, Lee A at all. Health Effects of Overweight and Obesity in 195 Countries over 25 Years. New England Journal of Medicine. 2017;377(1):13–27.
• 8. Gbejuade H, Squire J, Dixit A, Kaushik V, Mangwani J. Ultra-sound-guided regional anaesthesia in foot and ankle sur-gery. Journal of Clinical Orthopaedics and Trauma. 2020;11(3):417–421.
• 9. Hand WR, Taylor JM, Harvey NR, Epperson TI, Gunselman RJ, Bolin ED, et al. Thoracolumbar interfascial plane (TLIP) block: a pilot study in volunteers. Canadian Journal of Anesthesia/Journal canadien d’anesthésie. 2015;62(11):1196–1200.
• 10. Kaufman MW, Nguyen C, Meng Y, Roh E. Posterior intra-articular hip injections: a pilot study investigating a new approach. Journal of Ultrasound. 2024;Epub ahead of print.
• 11. Lewis SR, Price A, Walker KJ, McGrattan K, Smith AF. Ultra-sound guidance for upper and lower limb blocks. Cochrane Database of Systematic Reviews. 2015;11(2015(9)):CD006459.
• 12. Li C, Jia J, Qin Z, Tang Z. The use of ultrasound-guided mo-dified thoracolumbar interfascial plane (TLIP) block for mul-ti-level lumbar spinal surgery. Journal of Clinical Anesthe-sia. 2018;46:49–51.
• 13. Marhofer P, Harrop-Griffiths W, Kettner SC, Kirchmair L. Fifteen years of ultrasound guidance in regional anaesthe-sia: Part 1. British Journal of Anaesthesia. 2010;104(5):538–546.
• 14. Mowafy SMS, Abd Ellatif SE. Transcranial Doppler role in prediction of post-dural puncture headache in parturients undergoing elective cesarean section: prospective observa-tional study. Journal of Anesthesia. 2019;33(3):426–434.
• 15. Pavithran P, Sudhakaran R, Sudarshan PK, Eliyas S, Sekhar B, Kaniachallil K. Comparison of thoracolumbar interfascial plane block with local anaesthetic infiltration in lumbar spi-ne surgeries – A prospective double-blinded randomised controlled trial. Indian Journal of Anaesthesia. 2022;66(6):436–441.
• 16. Ruiz-Tovar J, Albrecht E, Macfarlane A, Coluzzi F. The TAP block in obese patients: pros and cons. Minerva Anestesio-logica. 2019;85(9):1024–1031.
• 17. Tantri AR, Rahmi R, Marsaban AHM, Satoto D, Rahyussalim AJ, Sukmono RB. Comparison of postoperative IL-6 and IL-10 levels following Erector Spinae Plane Block (ESPB) and classical Thoracolumbar Interfascial Plane (TLIP) block in a posterior lumbar decompression and stabilization procedu-re: a randomized controlled trial. BMC Anesthesiology. 2023;23(1):13.
• 18. Toshniwal G, Soskin V. Ultrasound-guided transversus abdominis plane block in obese patients. Indian Journal of Anaesthesia. 2012;56(1):104–105.
• 19. Tulgar S, Selvi O, Senturk O, Serifsoy TE, Thomas DT. Ultra-sound-guided Erector Spinae Plane Block: Indications, Complications, and Effects on Acute and Chronic Pain Based on a Single-center Experience. Cureus. 2019;11(1):e3815.
• 20. White L, Ji A. External oblique intercostal plane block for upper abdominal surgery: use in obese patients. British Jo-urnal of Anaesthesia. 2022;128(5):e295–e297.
• 21. Xu JL, Doherty T, Patel R, Galeno J, Dotzauer B. Analgesic efficacy of ultrasound-guided modified thoracolumbar in-terfascial plane block performed with the use of neurophy-siology monitoring for postoperative lumbar surgery. Jour-nal of Clinical Anesthesia. 2019;52:21–23.