Efficacy of transversalis fascia plane block for postoperative analgesia in lliac crest bone grafting - A triple blind, prospective randomised study

Abstract

Background: Iliac crest bone grafting (ICBG) can cause intense postoperative pain, often exceeding that of the primary surgical site, leading to suboptimal outcomes and prolonged recovery.Objective: To determine whether a transversalis fascia plane (TFP) block enhances postoperative analgesia and reduces opioid use compared with placebo after anterior ICBG for upper limb surgery in a triple-blind trial.Methods: Conducted this triple-blind, randomised study at Indira Gandhi Institute of Medical Sciences, Patna, Bihar (4th September 2020–31st October 2022). Sixty adults undergoing upper limb surgery requiring anterior iliac crest bone graft were assigned to either an ultrasound-guided TFP block (0.5% bupivacaine–epinephrine) or 5% dextrose placebo, with standard general anaesthesia and postoperative analgesia. Rescue morphine consumption was recorded.Results: In total, 60 patients (30 per group) completed the trial. Postoperative morphine use at 24 hours was significantly lower in the TFP block group (12.3 ± 2.2 mg) compared with controls (27.1 ± 5.0 mg; p<0.001), indicating a 54.5% reduction. Mean time to first analgesia was prolonged in the TFP group by 4.9 hours (6.2 ± 1.1 vs 1.3 ± 0.4 hours; p<0.001). Intraoperative fentanyl supplementation was required by 10% of TFP recipients versus 100% of controls (p<0.0001). No major adverse events or opioid-related side effects were observed. Overall, TFP patients reported lower 24-hour VAS scores and significantly improved satisfaction compared with those receiving placebo.Conclusion: TFP block is a safe, effective strategy for reducing donor-site pain and opioid requirements following anterior ICBG. Its targeted approach can enhance patient comfort and potentially improve long-term clinical outcomes.