Analgesic Efficacy of Quadratus Lumborum vs. Transversalis Fascia Block in Inguinal Hernia Surgery

November 24, 2025 updated by: SERPİL ŞEHİRLİOĞLU, Gaziosmanpasa Research and Education Hospital

Comparison of the Postoperative Analgesic Efficacy of Quadratus Lumborum Block and Transversalis Fascia Block in Inguinal Hernia Surgery

It is planned to compare the postoperative analgesic efficacy of the Transversalis Fascia Plane Block and the anterior Quadratus Lumborum Block in elective inguinal hernia surgeries.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

It is planned to compare the postoperative analgesic efficacy of the Transversalis Fascia Plane Block and the anterior Quadratus Lumborum Block in elective open inguinal hernia surgeries.

Primary Objective: Our primary aim is to compare and evaluate the time to first rescue analgesic requirement after the application of anterior Quadratus Lumborum Block and Transversalis Fascia Plane Block in patients undergoing elective open inguinal hernia surgeries under spinal anesthesia.

Secondary Objectives:

To compare the total analgesic consumption in the first 24 hours postoperatively.

To compare the Numeric Rating Scale (NRS) values (at rest and dynamic) of patients at postoperative follow-ups at 2, 4, 8, 12, and 24 hours.

To compare postoperative side effects such as nausea and vomiting. In trunk blocks, local anesthetic is applied to the interfascial area between the anterior abdominal wall or back muscles. Due to the lack of blood circulation and vascularization in the interfascial area, the absorption of local anesthetics is slow, allowing for prolonged analgesic effects. For this reason, trunk blocks are used as part of multimodal analgesia. The effectiveness of trunk blocks can vary based on the patient's structural anatomical differences and previous surgeries, but an average analgesic effect of 8-12 hours is typically observed. Sometimes, analgesic effects have been reported to last up to 24 hours.

Pain that arises from elective laparoscopic inguinal hernia surgeries can negatively impact postoperative immobilization, atelectasis, pneumonia due to atelectasis, and prolonged hospital stays. Due to the side effects associated with opioid medications used for postoperative analgesia, such as nausea, vomiting, itching, constipation, and dependency, non-opioid analgesic medications and regional techniques are used as part of multimodal analgesia to reduce opioid use.

Quadratus Lumborum and Transversalis Fascia Blocks can be safely and easily performed, especially in lower abdominal surgery, due to advancements in trunk blocks and ultrasound technology in recent years.

This study aims to evaluate the postoperative analgesic efficacy of Quadratus Lumborum Blocks and Transversalis Fascia Blocks administered to patients undergoing elective inguinal hernia surgery. The Transversalis Fascia Block can be utilized in lower abdominal surgeries by blocking the ilioinguinal, iliohypogastric nerves, and the T12 intercostal nerve. The Quadratus Lumborum Block provides analgesic efficacy in the T7-L2 dermatomal area.In patients planned for elective laparoscopic inguinal hernia surgery, informed consent was obtained after detailed information was provided. The patients were randomly divided into two groups using closed envelope randomization: the anterior Quadratus Lumborum Block group and the Transversalis Fascia Block group.

All patients will be taken to the block room after the surgery. All blocks will be performed under ultrasound guidance by the same anesthesia specialist while the patients are in the lateral decubitus position, with the surgical sites facing up.

In the Quadratus Lumborum block group, in the lateral decubitus position, a convex ultrasound probe will be sterilely placed in the subcostal area and above the iliac crest. The quadratus lumborum and psoas major muscles, as well as the L4 vertebra's transverse process, will be visualized. Using the in-plane technique and a 22G 100 mm peripheral block needle, the placement will first be identified through hydrodissection in the subfascial area between the quadratus lumborum and psoas major muscles. After localization, 20 mL of 0.5% bupivacaine will be injected slowly, aspirating every 5 cc, while visualizing the local anesthetic pushing the fascia in the ultrasound image.

In the Transversalis Fascia Block group, the same procedure will be followed as in the Quadratus Lumborum block group, with the ultrasound probe being placed in the same location, and the same in-plane technique will be applied with a 22G 100 mm peripheral block needle. After hydrodissection, 20 mL of 0.5% bupivacaine will be injected slowly in the same manner.

All patients will be monitored for 30 minutes in the block room after the block application.

All patients will receive anesthesia using the same technique under spinal anesthesia with bupivacain 12 mg intratechal space before surgery. At the end of the operation, all patients will receive intravenous 1g of paracetamol for postoperative analgesia. Routine extubation will be performed, and patients will be sent to the ward after recovery.

Postoperative analgesia for patients was planned as paracetamol 4x1g. Patients will be followed up by a different blinded anesthesia assistant from the one who performed the block at 2, 4, 8, 12, and 24 hours. The first rescue analgesia times, NRS scores (evaluated on a scale of 1 to 10, where 0 means no pain and 10 means very severe pain), postoperative side effects, and total analgesic amounts used in 24 hours will be recorded.

In postoperative follow-ups, for patients with NRS scores greater than 3, intravenous ibuprofen will be planned as rescue analgesia in the ward. If pain does not resolve within 30 minutes, dexketoprophen 50 mg IV will be planned.

In trunk blocks, blocking the thoracoabdominal nerves that travel between the fascia with local anesthetics is thought to provide analgesia during the postoperative period, increasing patient comfort, reducing postoperative opioid consumption and dependency, facilitating early mobilization, shortening the hospital stay, and minimizing opioid side effects.

Study Type

Interventional

Enrollment (Estimated)

60

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Ages 18-65
  • ASA Classification 1-2

Exclusion Criteria:

  • Allergy to local anesthetics
  • Presence of infection at the procedure site
  • BMI > 35 kg/m²
  • Bleeding disorders or anticoagulant use
  • Chronic analgesic or opioid use
  • Mental or psychiatric disorders
  • ASA Classification 3-4 patients(Severe COPD, history of cerebrovascular events, liver and kidney disease will be excluded from the study.)

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Supportive Care
  • Allocation: Randomized
  • Interventional Model: Crossover Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: anterior quadratus lumborum block
The anterior QLB block will be applied on the operative side
Procedure: Anterior Quadratus Lumborum Block (QLB)
In the Quadratus Lumborum block group, in the lateral decubitus position, a convex ultrasound probe will be sterilely placed in the subcostal area and above the iliac crest. The quadratus lumborum and psoas major muscles, as well as the L4 vertebra's transverse process, will be visualized. Using the in-plane technique and a 22G 100 mm peripheral block needle, the placement will first be identified through hydrodissection in the subfascial area between the quadratus lumborum and psoas major muscles. After localization, 20 mL of 0.25% bupivacaine will be injected slowly, aspirating every 5 cc, while visualizing the local anesthetic pushing the fascia in the ultrasound image.
Active Comparator: transversalis fascia group
the Transversalis Fascia Block will be applied on the operative side
Procedure: Transversalis Fascia Plane Block
In the Transversalis Fascia Block group, the same procedure will be followed as in the Quadratus Lumborum block group, with the ultrasound probe being placed in the same location, and the same in-plane technique will be applied with a 22G 100 mm peripheral block needle. After hydrodissection, 20 mL of 0.25% bupivacaine will be injected slowly in the same manner.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
time to first rescue analgesic requirement.
Time Frame: 24 hour
Our primary aim is to compare and evaluate the time to first rescue analgesic requirement after the application of anterior Quadratus Lumborum Block and Transversalis Fascia Plane Block in patients undergoing elective inguinal hernia surgeries under spinal anesthesia.
24 hour

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Total Opioid Consumption
Time Frame: 24 hour
To compare the total analgesic consumption in the first 24 hours postoperatively.
24 hour
To compare the NRS (Numering rating scale) values (resting and dynamic) at 2. 4. 8. 12 . 24. hours in the postoperative follow-up of the patients
Time Frame: 24 hour
Assessed at various time points to quantify pain intensity at rest and during movement. The Numerical Rating Scale (NRS) is a pain assessment tool where patients rate their pain from 0 (no pain) to 10 (worst pain).
24 hour

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Gaziosmanpasa Research and Education Hospital

Investigators

  • Principal Investigator: Serpil Sehirlioglu, MD, Gaziosmanpasa Research and Education Hospital

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

November 1, 2024

Primary Completion (Estimated)

June 1, 2026

Study Completion (Estimated)

June 10, 2026

Study Registration Dates

First Submitted

October 27, 2024

First Submitted That Met QC Criteria

October 28, 2024

First Posted (Actual)

October 29, 2024

Study Record Updates

Last Update Posted (Actual)

December 1, 2025

Last Update Submitted That Met QC Criteria

November 24, 2025

Last Verified

November 1, 2025

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • GaziosmanpasaTREH-FT-İH

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

The data associated with the paper are not publicly available but are available from the corresponding author on reasonable request.

IPD Sharing Time Frame

always

IPD Sharing Access Criteria

drserpilsahin@gmail.com

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL
  • SAP
  • ICF
  • CSR

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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