Comparison of Postoperative Analgesic Efficacy of Ultrasound-Guided Ilioinguinal-Iliohypogastric Block, Transversus Abdominis Plane Block, and Quadratus Lumborum Block in Inguinal Hernia Surgery

Not Applicable

Completed

• Conditions: Inguinal Hernia; Transversus Abdominis Plane (TAP) Block; Iliohypogastric/Ilioinguinal Nerve Block; Quadratus Lumborum Block

• Registration Number: NCT06997536
• Lead Sponsor: Namik Kemal University

Brief Summary

Inguinal hernia is a common condition, particularly among male patients, and represents one of the most frequent indications for lower abdominal surgeries. Postoperative acute pain and, more importantly, the progression of acute pain into chronic pain, remain significant challenges in the postoperative period. Effective postoperative pain management is therefore crucial in inguinal hernia repair.

In addition to systemic analgesia, various regional anesthesia techniques are employed in this setting. In recent years, peripheral nerve blocks such as the ilioinguinal-iliohypogastric (IL/IH) block, transversus abdominis plane (TAP) block, and quadratus lumborum block (QLB) have gained popularity for postoperative analgesia. These techniques offer several advantages, including reduced opioid consumption and decreased need for additional analgesics, while also minimizing hemodynamic instability and facilitating early mobilization.

The IL/IH block is performed by injecting a local anesthetic into the fascial plane between the transversus abdominis and internal oblique muscles, targeting the ilioinguinal and iliohypogastric nerves, which are branches of the L1 spinal nerve. The TAP block, first described by Rafi in 2001, involves injecting local anesthetic into the fascial plane between the internal oblique and transversus abdominis muscles within the Petit triangle, where the T6-T11 spinal nerve branches responsible for abdominal wall innervation are located. The quadratus lumborum block (QLB) was initially described by Blanco. The first version, known as QLB1, involves posterior injection of local anesthetic lateral to the quadratus lumborum muscle. In 2013, Jens Børglum introduced the transmuscular variant (QLB3), where the local anesthetic is administered between the quadratus lumborum and psoas muscles.

In this study, we aimed to compare postoperative outcomes in patients undergoing inguinal hernia repair under spinal anesthesia, with and without additional peripheral nerve blocks (IL/IH block, TAP block, and QLB). Specifically, we evaluated pain levels using the Visual Analog Scale (VAS) at the 30th minute, 2nd, 6th, 12th, and 24th hours postoperatively. We also assessed opioid-related side effects such as nausea and vomiting associated with patient-controlled analgesia (PCA) using tramadol, the total bolus and infusion doses of tramadol administered, and the amount of additional analgesia in the form of paracetamol. These outcomes were compared among the different block groups and with a control group that received only spinal anesthesia without any additional block.

Detailed Description

Not available

Study Timeline

• Study Start: 2022-06-28
• Primary Completion: 2023-06-28
• Study Completion: 2024-05-01
• Status Verified: 2025-05
• Study First Submitted: 2025-05-21
• Study First Submitted QC: 2025-05-21
• Last Update Submitted: 2025-05-21
• Study First Posted: 2025-05-30
• Last Update Posted: 2025-05-30

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 80

Inclusion Criteria

• Patients classified as ASA I and II
• Patients aged 18 to 75 years
• Patients undergoing unilateral inguinal hernia surgery under spinal anesthesia

Exclusion Criteria

• Patients with preoperative neurological sequelae
• Patients with a BMI >30
• Patients who refused to participate in the study

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: FACTORIAL

Primary Outcome Measures

Name	Time	Method
Postoperative Pain Score	Postoperative 30th minute, 2nd, 6th, 12th and 24th hours	Postoperative pain will be assessed using a Visual Analog Scale (VAS) ranging from 0 (no pain) to 10 (the worst imaginable pain). Pain scores will be recorded at predefined time points during rest and movement.

Secondary Outcome Measures

Name	Time	Method
Total Opioid Consumption at 24 Hours.	At the end of the 24th hour	For patient-controlled analgesia, tramadol 300 mg was prepared in 100 cc of isotonic saline with a concentration of 3 mg/cc. The infusion rate was set at 3 mL/hour, with a 5 mL bolus dose, a lock-out time of 4 hours, and the device was set to be used for 24 hours. In patients with a VAS score of 4 or higher despite opioid demand from the patient-controlled analgesia device, an additional 1 gram of IV paracetamol was planned to be administered as an adjunct analgesic. Total infusion and bolus doses of tramadol over 24 hours were recorded.

Trial Locations

Locations (1)

Namik Kemal University; 🇹🇷 Tekirdağ, Turkey