Thoracolumbar Interfascial Plane Block and Transversus Abdominis Plane Block for Postoperative Analgesia: 2-Dimensional Operative Video

While spinal fusion in properly selected patients has been shown to be effective in improving pain, function, and quality of life, many patients continue to have reservations regarding the historical morbidity associated with surgical intervention.1 Open lumbar fusion surgery traditionally is perceived as an intervention that is associated with significant pain, recovery time, and risk. Even though most patients ultimately recover from this procedure, they are often left scarred with the psychological, economic, and social costs.2  To combat these negative associations with spinal fusion, neurosurgeons have begun to adopt adjunctive treatment modalities, including thoracolumbar interfascial plane (TLIP) blocks and transversus abdominis plane (TAP) blocks to improve pain control and reduce postoperative opiate consumption.3,4 The TLIP block is done after the patient is intubated and prior to skin incision for our posterior lumbar cases. Recently, we have also begun placing TAP blocks for patients undergoing anterior lumbar interbody fusion (ALIF) using exclusively liposomal bupivacaine, as commonly practiced for other abdominopelvic surgeries, to lengthen the duration of analgesia.5 We have found that these blocks have ameliorated both intraoperative and postoperative pain management.6  In this video, we present a case of a 65-yr-old female who presented with a grade 1 spondylolisthesis and neuroforaminal compression from L4 to S1, who was treated with combined TAP and TLIP block followed by a L4 to S1 ALIF with posterolateral instrumentation.  Informed written consent was obtained from the patient and her family.