Comparison of Local Anesthetic Infiltration and Different Fascial Plane Blocks in Inguinal Hernia Repair

Not Applicable

• Conditions: Postoperative Pain; Inguinal Hernia; Local Infiltration; Quality of Recovery; Transversus Abdominis Plane Block; Quadratus Lumborum Block
• Interventions: Procedure: Transversus abdominis plane block; Procedure: Anterior quadratus lumborum block; Procedure: Local infiltration

• Registration Number: NCT05847842
• Lead Sponsor: Eskisehir Osmangazi University

Brief Summary

In this study, quadratus lumborum block (QLB), transversus abdominis plane (TAP) block, and local anesthetic infiltration will be performed preoperatively in patients who will undergo unilateral inguinal herniorrhaphy operation under general anesthesia. Quality of recovery (QoR-15) score, postoperative acute and chronic pain levels will be evaluated.

Detailed Description

Inguinal hernia repair, one of the most common operations, causes moderate to severe postoperative pain. The postoperative pain delays patients' recovery and return to daily life, increases the rate of readmission to the hospital, and can lead to persistent postoperative pain.Procedure-specific postoperative pain management (PROSPECT) recommendations for optimal pain management have been recently updated. Accordingly, in addition to preoperative or intraoperative paracetamol and nonsteroidal anti-inflammatory analgesics, local anesthetic infiltration and/or regional analgesia techniques (ilio-inguinal nerve blocks or TAP block) with rescue opioids are recommended. Also, it has been reported that further research is needed on new regional techniques (other fascial plane blocks etc).It has been shown that QLB potentially results in extensive sensory blockade (T7-12), and in cadaver studies, the iliohypogastric and ilioinguinal nerves are constantly involved. In addition, there are studies suggesting that it provides much longer analgesia than TAP block. There are few studies on its efficacy in inguinal hernia repair that are in pediatric cases or performed in addition to central blocks. It is hypothesized that QLB may provide better and longer analgesia, may increase the quality of recovery and reduce the development of resistant chronic pain, compared to other regional methods such as local infiltration or TAP block, that proven effectiveness.

Study Timeline

• Study Start: 2023-04-01
• Study First Submitted: 2023-04-18
• Study First Submitted QC: 2023-05-04
• Study First Posted: 2023-05-08
• Status Verified: 2025-02
• Last Update Submitted: 2025-02-27
• Last Update Posted: 2025-03-03
• Primary Completion: 2025-04-01
• Study Completion: 2025-04-01

Recruitment & Eligibility

• Status: ENROLLING_BY_INVITATION
• Sex: All
• Target Recruitment: 90

Inclusion Criteria

• Patients who will undergo elective unilateral inguinal herniorrhaphy under general anesthesia
• American Society of Anesthesiology (ASA) physical classification I-III

Exclusion Criteria

• Patients who will undergo laparoscopic surgery
• Previous inguinal hernia repair surgery
• A history of opioid use or pain management
• Coagulopathy or anticoagulant use
• Patients who have difficulty communicating or who are not cooperative

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Group T	Transversus abdominis plane block	Transversus abdominis plane block
Group Q	Anterior quadratus lumborum block	Anterior quadratus lumborum block
Group L	Local infiltration	Local infiltration

Primary Outcome Measures

Name	Time	Method
Quality of recovery assessed by Quality of recovery scale (QoR-15)	Postoperative 24th hour.	The 15-item quality of recovery (QoR-15) scale is a questionnaire used to evaluate the postoperative recovery quality of patients in the early postoperative stages. The QoR-15 score comprises 15 questions that assess 5 recovery domains, namely, physical comfort, physical independence, psychological support, emotional status, and pain. Each question is scored from 0 to 10 (0 none of the time to 10 all of the time).

Secondary Outcome Measures

Name	Time	Method
Postoperative pain assessed by Numerical Rating Scale (NRS)	At the 2nd, 6th, 12th, 24th and 36th hours	Postoperative pain levels during rest and movement (from supine to sitting position) will be evaluated by Numerical rating scale (0-no pain; 10-unbearable pain)
Postoperative chronic pain assessed by Numerical Rating Scale (NRS)	Three months later the operation date	Patients will be called by phone and the presence of chronic pain will be questioned with the Numerical Rating Scale (0-no pain; 10-unbearable pain).
Postoperative neuropathic pain assessed by Douleur neuropathic pain (DN4) scale.	Three months later the operation date	Patients will be called by phone and the presence of neuropathic pain pain will be questioned with the Douleur neuropathic pain (DN4) scale.; The items of the DN4 are scored based on a yes (1 point) /no (0 points) answer. This leads to a score range of 0-10.

Trial Locations

Locations (2)

Eskisehir Osmangazi University Faculty of Medicine; 🇹🇷 Eskisehir, Turkey

Eskisehir Osmangazi Universty; 🇹🇷 Eskişehir, Turkey