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Korean J Anesthesiol > Epub ahead of print
DOI: https://doi.org/10.4097/kja.d.18.00352    [Epub ahead of print]
Published online March 19, 2019.
The analgesic efficacy of the transversalis fascia plane (TFP) block in iliac crest bone graft harvesting: a randomized controlled trial
Nicholas D. Black1, Laith Malhas2, Rongyu Jin1, Anuj Bhatia1, Vincent W. S. Chan1, Ki Jinn Chin1
1Department of Anesthesia, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, Ontario
2Department of Anaesthesia, University Hospitals Coventry and Warwickshire NHS Trust, United Kingdom
Corresponding author:  Ki Jinn Chin, Tel: 416-603-5118, Fax: 416-603-6494, 
Email: gasgenie@gmail.com
Received: 11 December 2018   • Revised: 6 March 2019   • Accepted: 12 March 2019
Iliac crest bone graft (ICBG) harvesting is associated with significant perioperative pain and opioid consumption. Retrospective studies indicate the transversalis fascia plane (TFP) block can provide analgesia for anterior ICBG harvesting. We conducted a randomized controlled trial to establish the efficacy of the TFP block in this setting.
Fifty patients undergoing wrist fusion surgery with anterior ICBG harvesting were randomized to receive a TFP block with either 20 mL of 0.5% ropivacaine or 5% dextrose. Patients additionally received a brachial plexus block for primary surgical site anesthesia and either a general or spinal anesthetic depending on patient preference. The main outcomes of interest were perioperative opioid consumption (measured as intravenous morphine equivalents), pain intensity at the ICBG harvest site for up to 48 hours post-operatively and the incidence of persistent post-operative pain at 6 and 12 months after surgery.
; The TFP group used less opioid in the post-anesthetic care unit (PACU) (p=0.01) and in the first 8 hours following PACU discharge (p=0.02). The patients who received a TFP block also had lower pain scores in PACU (p<0.001). Although opioid consumption and pain scores were lower in the TFP group at later time points, this difference was not statistically significant. Persistent pain at the ICBG site on movement was reported in only 4.3% and 6.5% of all patients at 6 and 12 months respectively.
The TFP block provides effective early analgesia for anterior ICBG harvesting. The incidence of persistent postoperative pain was low in all patients.
Key Words: Anesthesia, conduction; Nerve block; Anesthesia, local; Fascia


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