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.
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).
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.
Parallel
Ultrasound-guided lateral quadratus lumborum block
Procedure/SurgeryUltrasound-guided lateral quadratus lumborum block. Local anesthetic: 30 ml of (Ropivacaine 0.2%) is injected at the appropriate fascial level.
Combined ilio-inguinal/ilio-hypogastric/genitofemoral (II-IH-GFN) block
Procedure/SurgeryUltrasound-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.
Cumulative opioid consumption in the first 24 hours postoperatively
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.
Pain intensity (VAS pain scores at rest )
Assesses the level of postoperative pain at rest using the Visual Analogue Scale (VAS), where 0 = no pain and 10 = worst imaginable pain.
Pain intensity (VAS pain scores at movement)
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
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
Percentage of patients who required additional opioid analgesics beyond the planned postoperative regimen, indicating inadequate analgesia from the primary block.
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Al-Azhar University
Lead sponsor
Benha University
Collaborator
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