Comparison of paravertebral, thoracolumbar interfascial plane, and retrolaminar blocks for postoperative analgesia in lumbar disc herniation surgery: A randomized controlled trial

Background: – The goal of this prospective randomized controlled experiment was comparing the analgesic efficacy, opioid needs, and adverse effect profiles of paravertebral (PVB) block, thoracolumbar interfascial plane (TLIP) block, and retrolaminar (RLB) block in patients undergoing lumbar disc herniation surgery. Methods: – One hundred eighty-five adults (American Society of Anesthesiologists I–III) undergoing elective lumbar disc herniation surgery made up this single-center study. Among the exclusion criteria were coagulation problems, injection site infection, allergy to local anesthetics, and incapacity to provide informed consent. Patients were randomly assigned into 4 groups: control (systemic analgesia only), PVB, TLIP, and RLB (45 patients per group). An expert anesthesiologist supervised the ultrasonography during each block. The visual analog scale was used to measure postoperative pain at 0, 1, 2, 6, 12, and 24 hours after surgery. This was the primary outcome. Motor block incidence, rescue morphine consumption, and quality of recovery-40 scores at 24 hours were secondary objectives. Unfavorable incidents were noted. Analysis of variance and Kruskal–Wallis tests (P < .05) were used to examine the data. Results: – At every time point, the TLIP and RLB groups’ visual analog scale scores were significantly lower than those of the PVB and control groups (P < .001). The TLIP and RLB groups consumed considerably less rescue morphine (P < .001). The TLIP and RLB groups had the highest quality of recovery-40 scores (P < .001). The PVB group had the highest incidence of motor block (26.7%), whereas the RLB group had the lowest rate (8.9%). There were no significant adverse effects noted. Conclusion: – Compared to PVB and control group, TLIP and RLB provide better and longer postoperative analgesia, smaller opioid needs, and higher-quality recovery. Their importance in improved recovery regimens following lumbar disc herniation surgery is supported by their good safety profile. Copyright © 2026 the Author(s). Published by Wolters Kluwer Health, Inc.