Background and goal of study: 
Spinal surgical procedures, including posterior lumbar interbody fusion and oncological spinal surgery, are associated with severe postoperative pain in the first few days. To enhance early functional outcome and ambulation, adequate pain management is paramount. Nowadays, multimodal pharmacological low opioid approach for postoperative analgesia is common practice. However, the use of loco regional anaesthesia techniques still seems controversial as hard evidence is lacking. In our hospital wound infiltration with local anaesthetics and multimodal analgesic low opioid approach for  these procedures are routine. Our hypothesis was that continuous administration of local anaesthetics simply administered under the posterior thoracolumbar fascia (TLF block) might result in improved analgesia, reduction of opioid use and earlier mobilization.

Materials and methods: 
After ethics approval we retrospectively analysed three patients who underwent major spinal surgery in whom post procedure wound infiltration catheters parallel to the wound, just below the thoracolumbar fascia were placed using a blind, loss of resistance technique. Primary outcome measures were ASA classification, VAS scores, PONV-scores, opioid use and time to full mobilisation.  

Results and discussion:
Three patients could be identified (M/F=2/1, ASA II/III=2/1, age 72.3 y (range 69-74).The VAS scores are shown in table 1. Opioid consumption is shown in table 2. No patients showed PONV. Full mobilization was achieved at day 1 in two patients and at day 3 in one patient. There were no 30-days readmissions or re-operations reported.  

Conclusion(s): 
The use of a continuous thoracolumbar fascia (TLF) block led to low pain scores, reduced time to mobilization and low opioid use in the first four days after the procedure. Continuous TLF block may be a promising new technique for enhanced recovery after major spinal surgery. 

06 / Continuous Thoracolumbar Fascia Block, a new promising block for analgesia in major spinal surgery