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LETTERS TO EDITOR
Year : 2020  |  Volume : 14  |  Issue : 1  |  Page : 137-138

A case of extensive epidural anesthesia with ultrasound-guided thoracolumbar interfascial plane block technique


1 Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
2 Department of Anesthesiology, Beijing Haidian Maternal and Child Health Hospital, Beijing, China

Correspondence Address:
Dr. Yun Wang
Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sja.SJA_291_18

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Date of Submission05-May-2019
Date of Acceptance08-May-2019
Date of Web Publication6-Jan-2020
 


How to cite this article:
Ma D, Guo M, Li X, Wang Y. A case of extensive epidural anesthesia with ultrasound-guided thoracolumbar interfascial plane block technique. Saudi J Anaesth 2020;14:137-8

How to cite this URL:
Ma D, Guo M, Li X, Wang Y. A case of extensive epidural anesthesia with ultrasound-guided thoracolumbar interfascial plane block technique. Saudi J Anaesth [serial online] 2020 [cited 2020 Jan 18];14:137-8. Available from: http://www.saudija.org/text.asp?2020/14/1/137/275099



Sir,

The ultrasound-guided thoracolumbar interfascial plane (TLIP) block, which can be used for the analgesia for patients undergoing lumbar vertebra surgery, was first reported in 2015.[1] The injection of local anesthetic (LA) into the fascial plane between the multifidus and longissimus muscles at the level of the third lumbar vertebra (L3) can block the adjacent dorsal rami of the spinal nerves. As a new technology, its indications and contraindications have not been clearly defined. In this report, we present one case with extensive epidural anesthesia after the TLIP block.

A 52-year-old male underwent posterior midline approach for lumbar decompression and fusion at L4-S1, and he had done nucleus pulposus extraction in a small incision 10 years before. After identifying the multifidus muscle and the longissimus muscle at approximately the level of L3 using a low-frequency curvilinear ultrasound probe, 0.5% ropivacaine 40 mL in total (20 mL injected into each side) were injected into the fascial plane between the multifidus and longissimus muscles. We did not test the loss of sensation after block application, and the general anesthesia was performed using total intravenous anesthesia (propofol, remifentanil, and rocuronium). Anesthesia was maintained with 50–60 ug/kg/min propofol and 0.10–0.15ug/kg/min remifentanil. About 30 min after the block, persistent hypotension occurred, and norepinephrine 0.02–0.05 ug/kg/min was pumped all through the operation, which lasted for 6 h. After the operation, the administration of intravenous drugs was stopped, and the blood pressure returned to normal. The patient was able to breathe spontaneously, the tidal volume was more than 250 ml, and the tracheal tube was removed. However, the patient presented with myasthenia of limbs and the decreased sensation of the skin below the clavicle. The sensation and motor function of the patient began to recover 10 h after the block. Then, the patient was transferred to the Intensive Care Unit, and his sensation and motor function were fully recovered in 24 h after the block.

Through this case, we think we should not do the conventional TLIP block on the patients after lumbar surgery, because a large dose of LA may enter the spinal canal through the changed anatomical structure and cause extensive epidural anesthesia. The modified approach may be a safe and alternative way for these patients.[2] The LA is injected at the fascial plane between the iliocostalis muscle and longissimus muscle. Compared with conventional TLIP block, the modified TLIP block may have a decreased risk of extensive epidural anesthesia and infection.[3]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given his consent for his images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hand WR, Taylor JM, Harvey NR, Epperson TI, Gunselman RJ, Bolin ED, et al. Thoracolumbar interfascial plane (TLIP) block: A pilot study in volunteers. Can J Anaesth 2015;62:1196-200.  Back to cited text no. 1
    
2.
Ahiskalioglu A, Alici HA, Selvitopi K, Yayik AM. Ultrasonography-guided modified thoracolumbar interfascial plane block: A new approach. Can J Anaesth 2017;64:775-6.  Back to cited text no. 2
    
3.
Ahiskalioglu A, Yayik AM, Doymus O, Selvitopi K, Ahiskalioglu EO, Calikoglu C, et al. Efficacy of ultrasound-guided modified thoracolumbar interfascial plane block for postoperative analgesia after spinal surgery: A randomized-controlled trial. Can J Anaesth 2018;65:603-4.  Back to cited text no. 3
    




 

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