Lumbar microdiscectomy is a commonly used surgical procedure for treating herniated discs. Effective postoperative analgesia is crucial for early mobilization and functional recovery. Uncontrolled postoperative pain can delay recovery, increase the risk of opioid dependence, and lead to respiratory complications.
Although opioid analgesics effectively reduce pain, they can cause side effects such as nausea, vomiting, respiratory depression, and dependency. Therefore, non-opioid analgesic methods are preferred for patient safety and comfort. Recently, regional anesthesia techniques such as the Thoracolumbar Interfascial Plane (TLIP) block and the Quadro Iliac Plane Block have been introduced for postoperative pain management in lumbar surgeries. However, there are not enough studies comparing the superiority of these two methods.
Study Objective: The primary aim of this study is to evaluate the effects of ultrasound-guided TLIP and Quadro Iliac Plane Blocks on postoperative opioid consumption after lumbar microsurgery. The secondary aim is to compare opioid-related side effects (such as nausea, vomiting, respiratory depression, etc.) and postoperative NRS pain scores between the groups.
Patients aged 18 to 80 years
American Society of Anesthesiologists (ASA) physical status I to III
scheduled for lumbar microdiscectomy surgery
Known allergy to local anesthetics
Any other significant drug allergies related to the study interventions
Pregnancy
Pre-existing psychiatric or neurological disorders
Parallel
Standard Analgesia (No Block)
Procedure/SurgeryParticipants receive standard perioperative analgesia (including intravenous paracetamol/tramadol), but no additional regional block is applied.
Thoracolumbar Interfascial Plane (TLIP) Block
Procedure/SurgeryIn addition to standard perioperative analgesia, a TLIP block is performed under sterile conditions and ultrasound guidance, after the surgical procedure is completed but before the patient is awakened. A total of 20 mL of 0.25% bupivacaine is injected into the thoracolumbar fascial plane, and spread is confirmed via ultrasound.
Quadro Iliac Plane Block
Procedure/SurgeryIn addition to standard perioperative analgesia, a Quadro Iliac Plane Block is performed under sterile conditions and ultrasound guidance, after the surgical procedure is completed but before the patient is awakened. A total of 20 mL of 0.25% bupivacaine is injected into the quadro iliac plane at the level of the iliac crest, and spread is confirmed via ultrasound.
tramadol consumption
Total tramadol consumption (mg) in the first 24 hours after surgery.
NRS (Numerical Rating Scale) pain scores
NRS (0-10) scores will be measured at 3, 6, 12, 18, and 24 hours during both rest and mobilization in the postoperative period.
opioid-related side effects (such as nausea, vomiting, respiratory depression)
The incidence of opioid-related side effects (e.g., nausea, vomiting, respiratory depression) will be recorded and compared between groups.
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