الفهرس 
Classification of pain
Deep musclesOnly 14 pages are availabe for public view
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Abstract
Severe postoperative pain following spine surgery is a significant cause of morbidity, extended length of facility stays, and marked opioid usage. Although the number of spinal surgeries performed has long increased, the methods available for perioperative pain management have remained limited. Regional analgesia techniques can play a significant role in multimodal analgesia but descriptions of their use in spine surgery are sparse. Enhanced Recovery after Surgery protocol recommends the use of regional anesthesia techniques to minimize opioid analgesics whenever possible. The spinal nerve is formed by the union of the ventral motor root and the dorsal sensory root. It subdivides as it exits the intervertebral canal, into a large anterior primary ramus and a smaller posterior primary ramus. The posterior ramus runs around the facet joints and gives branches supplying ligaments, joints, and all the segmental spinal muscles in addition to providing for the cutaneous supply over the back from the vertex to the coccyx. The thoracolumbar interfacial plane (TLIP) block is performed by injecting a local anesthetic drug into the fascial plane between the multifidus and longissimus muscles at the approximate level of the third lumbar vertebra. It has been reported to block the dorsal rami of the thoracolumbar nerves as they pass through the paraspinal musculature. The ESP block is a newly described regional anesthetic technique involving local anesthetic injection in a paraspinal plane deep to the erector spinae muscle. It was first described for thoracic neuropathic pain when performed at the T5 TP. Later when performed at further lower thoracic level, it was useful for abdominal surgeries. In this block, dorsal and ventral rami of both thoracic and abdominal nerves are blocked.