Comparison of TAP and QL Blocks for Postoperative Analgesia in Open Inguinal Hernia Repair

NCT07527065 | Enrolling By Invitation

• 2 other identifiers: 2025-149M.D. MEHMET YALVAC
• Study Type: interventional
• Target: 70
• Locations: 1 country
• Sites: 1

Brief Summary

Background Postoperative pain management after open inguinal hernia repair remains a clinical challenge despite spinal anesthesia. Ultrasound-guided fascial plane blocks, such as Transversus Abdominis Plane (TAP) block and Quadratus Lumborum Block (QLB), have been increasingly used as part of multimodal analgesia. This study aimed to compare their effects on postoperative opioid consumption. Methods After ethics committee approval, 70 patients aged 18-65 years with ASA I-II undergoing elective unilateral inguinal hernia repair were included in this prospective, randomized study. Patients were allocated into two groups: Group Q (QLB) and Group T (TAP). Blocks were performed preoperatively under ultrasound guidance using the in-plane technique with 30 mL of 0.25% bupivacaine. Block success was defined as sensory blockade at T10-L1 dermatomes at 30 minutes. All patients received spinal anesthesia at the L3-L4 level with 12.5 mg of 0.5% isobaric bupivacaine. Postoperatively, patient-controlled analgesia (PCA) with tramadol was administered for 24 hours. Pain scores were assessed using the Numeric Rating Scale (NRS) at PACU and at 1, 3, 6, 12, 18, and 24 hours. Opioid consumption was recorded at 0-1, 2-12, 12-24 hours, and cumulatively over 24 hours. Postoperative side effects were also evaluated. Results Both QLB and TAP block provided effective postoperative analgesia. There were no significant differences between the groups in terms of total 24-hour opioid consumption or NRS pain scores at measured time points. However, QLB demonstrated a trend toward prolonged analgesic duration and wider dermatomal spread. Conclusion Both TAP and QLB are effective adjuncts to spinal anesthesia for postoperative analgesia in unilateral inguinal hernia repair. While QLB may offer broader and longer-lasting analgesia, its superiority over TAP block in reducing opioid consumption was not statistically significant.

Conditions

Postoperative Pain

Keywords

open inguinal hernia repair; postoperative pain; transversus abdominis plane block; quadro-iliac plane block

Outcome Measures

Primary Outcomes (1)

• Postoperative Pain Examination with Numeric Rating Scale

  Determination of patients' post-operative pain level. The Numeric Rating Scale (NRS), a method that converts the patient's pain perception into a numerical form, will be used to assess postoperative pain. NRS has a numerical scale ranging from 0 to 10. The patient will rate the intensity of pain on a scale from 0, indicating no pain, to 10, representing the worst imaginable pain (NRS 0=no pain, 4=mild to moderate pain, 6-8=severe pain, and \>8=intolerable pain). The NRS score will be evaluated both at rest and during active movement situations (such as transitioning from a lying to a sitting position).

  24 hours

Study Arms (2)

Group T (Transversus Abmoninis Plane Block)

ACTIVE COMPARATOR

With the patient in the supine position, the needle insertion site will be sterilized with 10% povidone-iodine. A linear ultrasound probe will be covered in a sterile manner. A 22-25G, 50-100 mm peripheral nerve block needle will be used. The ultrasound probe will be placed at the level of the umbilicus along the midaxillary line. After identifying the three abdominal muscle layers, the fascial plane between the internal oblique and transversus abdominis muscles will be visualized. The needle will be advanced using the in-plane technique (medial-to-lateral or lateral-to-medial). A total of 30 mL of 0.25% bupivacaine will be injected into the fascial plane between the relevant muscle layers.

Procedure: Transversus Abmoninis Plane Block

Group Q ( Quadro-Iliac Plane Block)

ACTIVE COMPARATOR

With the patient in the prone position, the needle insertion site will be sterilized with 10% povidone-iodine, and the linear ultrasound probe will be prepared in a sterile manner. The probe will be positioned to visualize the L3 spinous process at the midline. After slight lateral movement, the transverse process within the erector spinae muscle will be identified. When the probe is rotated sagittally and moved caudally, the iliac crest will be visualized. The erector spinae, quadratus lumborum, and psoas major muscles will be identified. The needle will be advanced in-plane from cranial to caudal. After hydrodissection with 2 mL of normal saline, 30 mL of 0.25% bupivacaine will be injected.

Procedure: Quadro-Iliac Plane Block

Interventions

Transversus Abmoninis Plane Block PROCEDURE

With the patient in the supine position, the needle insertion site will be sterilized with 10% povidone-iodine. A linear ultrasound probe will be covered in a sterile manner. A 22-25G, 50-100 mm peripheral nerve block needle will be used. The ultrasound probe will be placed at the level of the umbilicus along the midaxillary line. After identifying the three abdominal muscle layers, the fascial plane between the internal oblique and transversus abdominis muscles will be visualized. The needle will be advanced using the in-plane technique (medial-to-lateral or lateral-to-medial). A total of 30 mL of 0.25% bupivacaine will be injected into the fascial plane between the relevant muscle layers.

Group T (Transversus Abmoninis Plane Block)

Quadro-Iliac Plane Block PROCEDURE

With the patient in the prone position, the needle insertion site will be sterilized with 10% povidone-iodine, and the linear ultrasound probe will be prepared in a sterile manner. The probe will be positioned to visualize the L3 spinous process at the midline. After slight lateral movement, the transverse process within the erector spinae muscle will be identified. When the probe is rotated sagittally and moved caudally, the iliac crest will be visualized. The erector spinae, quadratus lumborum, and psoas major muscles will be identified. The needle will be advanced in-plane from cranial to caudal. After hydrodissection with 2 mL of normal saline, 30 mL of 0.25% bupivacaine will be injected.

Group Q ( Quadro-Iliac Plane Block)

Eligibility Criteria

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

You may qualify if:

• Will undergo Open Inguinal Hernia Repair
• The American Society of Anesthesiologists (ASA) physical classification is 1-2.
• The volunteer has read and accepted the consent form
• Body mass index (BMI) \<35

You may not qualify if:

• Body mass index (BMI) \>35 kg/m²
• American Society of Anesthesiologists (ASA) physical status III-V
• Inability to assess pain using the Numeric Rating Scale (NRS)
• Known allergy to the local anesthetic or the planned analgesic agent
• Self-reported pregnancy or breastfeeding
• Age \<18 or \>65 years
• Uncontrolled anxiety
• Alcohol or substance abuse
• Neuromuscular disease or peripheral neuropathy
• Use of high-dose opioid medication within three days prior to surgery widespread chronic pain
• Diabetes mellitus
• Hepatic or renal insufficiency
• Coagulation disorders
• Current use of anticoagulant therapy
• Infection at the site of peripheral block needle insertion

Sponsors & Collaborators

• Hitit University: lead

Study Sites (1)

Hitit University Erol Olcok Training and Research Hospital,

Çorum, Merkez, 19200, Turkey (Türkiye)

Location

Related Publications (17)

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• Turan EI, Aslan C, Berber K, Sarban O, Sahin AS. Efficacy of quadro-iliac plane block in single level lumbar discectomies: a case series for novel block. Minerva Anestesiol. 2024 Dec;90(12):1159-1160. doi: 10.23736/S0375-9393.24.18314-9. Epub 2024 Sep 11. No abstract available.

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• Turan EI, Sahin AS. Quadro-iliac plane block (QIPB) in lumbar stabilisation surgeries: A case series. Indian J Anaesth. 2025 Feb;69(2):244-245. doi: 10.4103/ija.ija_1077_24. Epub 2025 Jan 29. No abstract available.

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• Turan EI, Baydemir AE, Sahin AS. Efficacy of the quadro-iliac plane block in postoperative pain management for proximal femoral nail surgeries. Minerva Anestesiol. 2025 Mar;91(3):221-223. doi: 10.23736/S0375-9393.24.18506-9. Epub 2024 Nov 4. No abstract available.

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MeSH Terms

Conditions

Pain, Postoperative

Condition Hierarchy (Ancestors)

Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Pain; Neurologic Manifestations; Signs and Symptoms

Study Officials

• MEHMET YALVAÇ, MD

  Hitit University Faculty of Medicine

  PRINCIPAL INVESTIGATOR

• Zeynep Kaya, MD

  Hitit University Faculty of Medicine

  PRINCIPAL INVESTIGATOR

• Serhat Özçiftçi, MD

  Hitit University Faculty of Medicine

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, INVESTIGATOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Resident doctor

Study Record Dates

• First Submitted: April 8, 2026
• First Posted: April 14, 2026
• Study Start: September 29, 2025
• Primary Completion: February 10, 2026
• Study Completion (Estimated): May 1, 2026
• Last Updated: April 16, 2026

Record last verified: 2026-04

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)