Postoperative Analgesia of Inguinal Hernia Repair in Adults
Conditions
Keywords
Quadratus lumborum [QL] block, Ilioinguinal-iliohypogastric (IIIH) nerve block, Genitofemoral block
Brief summary
This double-blind randomized controlled trial aimes to compares two ultrasound-guided regional techniques-lateral quadratus lumborum block versus combined ilio-inguinal/ilio-hypogastric/genitofemoral (II-IH-GFN) block-for postoperative analgesia after elective unilateral open inguinal hernia repair under spinal anesthesia in adults.
Interventions
PROCEDUREUltrasound-guided lateral quadratus lumborum block
Ultrasound-guided lateral quadratus lumborum block. Local anesthetic: 30 ml of (Ropivacaine 0.2%) is injected at the appropriate fascial level.
PROCEDURECombined ilio-inguinal/ilio-hypogastric/genitofemoral (II-IH-GFN) block
Ultrasound-guided ilio-inguinal and ilio-hypogastric block. Local anesthesia: 20 ml of 0.2% ropivacaine for ilio-inguinal and ilio-hypogastric block + 10 ml of 0.2% ropivacaine for genitofemoral anaesthesia, total injection volume = 30 ml.
Sponsors
Benha University
Al-Azhar University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Adults aged 18-75 years. * ASA physical status I-III. * Scheduled for elective unilateral open inguinal hernia repair under standardized spinal anesthesia. * Able to understand and use the Visual Analogue Scale (VAS). * Provided written informed consent.
Exclusion criteria
* Allergy to local anesthetics. * Coagulopathy or current use of anticoagulants contraindicating peripheral nerve blocks. * Infection at the injection site. * Chronic opioid use (daily opioids \>2 weeks) or chronic pain syndromes. * Body mass index (BMI) \>40 kg/m². * Conversion to other surgery or bilateral repair. * Pregnant patients. * Refusal to sign informed consent.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cumulative opioid consumption in the first 24 hours postoperatively | 24 hours after surgery. | Measures the total amount of opioid analgesics (expressed as morphine milligram equivalents, MME) consumed during the first postoperative 24 hours. It reflects overall analgesic efficacy of the two block techniques. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain intensity (VAS pain scores at movement) | 24 hours postoperatively. | Assesses the level of postoperative pain during movement using the Visual Analogue Scale (VAS), where 0 = no pain and 10 = worst imaginable pain. |
| Time to first analgesic request | 24 hours. | Determines the duration of effective analgesia provided by each block, defined as the interval from completion of the block to the first patient request for additional analgesia. |
| Proportion of patients requiring rescue opioid analgesia | 24 hours. | Percentage of patients who required additional opioid analgesics beyond the planned postoperative regimen, indicating inadequate analgesia from the primary block. |
| Pain intensity (VAS pain scores at rest ) | 24 hours postoperatively. | Assesses the level of postoperative pain at rest using the Visual Analogue Scale (VAS), where 0 = no pain and 10 = worst imaginable pain. |
| Patient satisfaction score | Assessed at 24 hours postoperatively. | Patient satisfaction with postoperative pain control will be evaluated using a 5-point Likert scale, allowing a simple yet reliable measure of the patient's overall analgesic experience. Each participant will rate their satisfaction as follows: 1 for very dissatisfied, indicating poor pain relief and marked discomfort; 2 for dissatisfied, reflecting inadequate but tolerable pain control; 3 for neutral, representing acceptable analgesia without a clear sense of satisfaction; 4 for satisfied, denoting good pain relief and minimal discomfort; and 5 for very satisfied, corresponding to excellent pain control and full contentment with the postoperative analgesia regimen. |
| Post-anesthesia care unit (PACU) stay duration | 24 hours | Measures the time spent in the PACU |
| Total hospital stay duration | 24 hours | Measures total length of hospital stay. |
| Incidence of postoperative block-related complications | 24 hours. | Evaluates safety of the blocks by recording complications such as hematoma, local anesthetic toxicity, or impaired mobility. |
Countries
Egypt
Contacts
Primary ContactNeveen A. Kohaf, Ph.D
Outcome results
None listed