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

NCT06997536 | Completed

• 1 other identifier: NamikKU-AGultekin-Meltem2025
• Study Type: interventional
• Target: 80
• Locations: 1 country
• Sites: 1

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.

Conditions

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

Keywords

Inguinal hernia; Ilioinguinal-iliohypogastric block; Transversus abdominis plane block; Quadratus lumborum block

Outcome Measures

Primary Outcomes (1)

• Postoperative Pain Score

  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.

  Postoperative 30th minute, 2nd, 6th, 12th and 24th hours

Secondary Outcomes (1)

• Total Opioid Consumption at 24 Hours.

  At the end of the 24th hour

Other Outcomes (2)

• Total nausea and vomiting count over 24 hours

  At the end of the 24th hour

• Need for additional analgesia

  At the end of the 24th hour

Study Arms (4)

Ilioinguinal/Iliohypogastric Block

EXPERIMENTAL

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

Procedure: Ilioinguinal/iliohypogastric Nerve Block

Transversus abdominis plane (TAP) block

EXPERIMENTAL

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

Procedure: Transversus abdominis plane (TAP) block

Quadratus Lumborum Block

EXPERIMENTAL

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

Procedure: Quadratus Lumborum Block (QLB)

Control

NO INTERVENTION

No block was applied after spinal anesthesia.

Interventions

Ilioinguinal/iliohypogastric Nerve Block PROCEDURE

The aim of this study is to compare the analgesic efficacy of IL/IH block, TAP block, and QLB applied in inguinal hernia cases operated under spinal anesthesia, with each other and with a control group that did not receive any additional block to spinal anesthesia.

Ilioinguinal/Iliohypogastric Block

Transversus abdominis plane (TAP) block PROCEDURE

The aim of this study is to compare the analgesic efficacy of IL/IH block, TAP block, and QLB applied in inguinal hernia cases operated under spinal anesthesia, with each other and with a control group that did not receive any additional block to spinal anesthesia.

Transversus abdominis plane (TAP) block

Quadratus Lumborum Block (QLB) PROCEDURE

The aim of this study is to compare the analgesic efficacy of IL/IH block, TAP block, and QLB applied in inguinal hernia cases operated under spinal anesthesia, with each other and with a control group that did not receive any additional block to spinal anesthesia.

Quadratus Lumborum Block

Eligibility Criteria

• Age: 18 Years - 75 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

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

You may not qualify if:

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

Sponsors & Collaborators

• Namik Kemal University: lead

Study Sites (1)

Namik Kemal University

Tekirdağ, 59020, Turkey (Türkiye)

Location

MeSH Terms

Conditions

Hernia, Inguinal; Bites and Stings

Interventions

Dental Occlusion

Condition Hierarchy (Ancestors)

Hernia, Abdominal; Hernia; Pathological Conditions, Anatomical; Pathological Conditions, Signs and Symptoms; Poisoning; Chemically-Induced Disorders; Wounds and Injuries

Intervention Hierarchy (Ancestors)

Dentistry; Dental Physiological Phenomena; Digestive System and Oral Physiological Phenomena

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: DIAGNOSTIC
• Intervention Model: FACTORIAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor

Study Record Dates

• First Submitted: May 21, 2025
• First Posted: May 30, 2025
• Study Start: June 28, 2022
• Primary Completion: June 28, 2023
• Study Completion: May 1, 2024
• Last Updated: May 30, 2025

Record last verified: 2025-05

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)