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

Namik Kemal University

Status: Completed

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

Treatments: Procedure: Transversus abdominis plane (TAP) block; Procedure: Ilioinguinal/iliohypogastric Nerve Block; Procedure: Quadratus Lumborum Block (QLB)

Study type: Interventional

Funder types: Other

Identifiers

NCT06997536

NamikKU-AGultekin-Meltem2025

Details and patient eligibility

About

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.

Enrollment: 80 patients

Sex: All

Ages: 18 to 75 years old

Volunteers: No Healthy Volunteers

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

Trial design

Primary purpose: Diagnostic

Allocation: Randomized

Interventional model: Factorial Assignment

Masking: Single Blind

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80 participants in 4 patient groups

Ilioinguinal/Iliohypogastric Block

Experimental group

Description:

After spinal anesthesia was applied, a preoperative ilioinguinal/iliohypogastric block was administered to the side to be operated on.

Treatment:

Procedure: Ilioinguinal/iliohypogastric Nerve Block

Transversus abdominis plane (TAP) block

Experimental group

Description:

After spinal anesthesia was applied, a preoperative transversus abdominis plane (TAP) block was administered to the side to be operated on.

Treatment:

Procedure: Transversus abdominis plane (TAP) block

Quadratus Lumborum Block

Experimental group

Description:

After spinal anesthesia was applied, a preoperative quadratus lumborum block (QLB) was administered to the side to be operated on.

Treatment:

Procedure: Quadratus Lumborum Block (QLB)

Control

No Intervention group

Description:

No block was applied after spinal anesthesia.