QIPB in Inguinal Hernia

Effect of the Quadro-Iliac Plane Block on Quality of Recovery Following Laparoscopic Inguinal Hernia Surgery: A Prospective, Randomized, Controlled, Double-Blind, Multicenter Study

Inguinal hernia repair is one of the most commonly performed surgical procedures. It is generally performed under regional anesthesia techniques, such as local anesthesia, peripheral nerve blocks, or neuraxial anesthesia (spinal or epidural anesthesia), or under general anesthesia. Despite various available analgesic regimens, numerous studies have demonstrated that postoperative pain control remains inadequate. Opioids, nonsteroidal anti-inflammatory drugs, and analgesics are frequently used for postoperative pain management. However, these medications are associated with uncertain efficacy and undesirable side effects. Pain is a critical factor in the postoperative period, contributing to delayed ambulation and paralytic ileus, ultimately hindering early discharge.

Study Overview

• Status: Recruiting
• Conditions: Postoperative Pain
• Intervention / Treatment: Other: Control group; Other: Quadro iliac plane block

Detailed Description

Inguinal hernia repair is one of the most commonly performed surgical procedures. It is generally performed under regional anesthesia techniques, such as local anesthesia, peripheral nerve blocks, or neuraxial anesthesia (spinal or epidural anesthesia), or under general anesthesia. Despite various available analgesic regimens, numerous studies have demonstrated that postoperative pain control remains inadequate. Opioids, nonsteroidal anti-inflammatory drugs, and analgesics are frequently used for postoperative pain management. However, these medications are associated with uncertain efficacy and undesirable side effects. Pain is a critical factor in the postoperative period, contributing to delayed ambulation and paralytic ileus, ultimately hindering early discharge. Recently, Tulgar and colleagues introduced a novel fascial plane block known as the "quadro-iliac plane block". Quadro-iliac plane block is performed within the quadro-iliac plane, located between the inner surface of the iliac crest and the posterior surface of the quadratus lumborum muscle. In their study, Tulgar et al. bilaterally injected 40 mL of methylene blue into the quadro-iliac plane. They observed widespread dye dispersion along the anterior and posterior surfaces of the quadratus lumborum muscle, transversalis fascia, ilioinguinal, iliohypogastric, subcostal, and genitofemoral nerves, as well as the lumbar plexus. Based on these findings, quadro-iliac plane block has been proposed as a potentially effective technique for managing acute or chronic pain in the lumbosacral, abdominal, and hip regions.

• Study Type: Interventional
• Enrollment (Estimated): 70
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Konya, Turkey (Türkiye)
    • Recruiting
    • Konya City Hospital
    • Contact: Muhammed H SATICI, M.D; Phone Number: +90 5455636333; Email: halit_satici@hotmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Patients aged 18-65 years
• Undergoing elective,
• unilateral laparoscopic inguinal hernia repair
• Receiving general anesthesia

Exclusion Criteria:

• Patients who refuse to provide consent
• Patients with contraindications to regional anesthesia
• Patients with impaired consciousness
• Patients with coagulopathy
• Patients with infections at the block site
• Emergency cases

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: control group; All patients will receive IV paracetamol (1 g, 3×1) and IV tenoxicam (20 mg, 2×1). Rescue analgesia (IV tramadol 1 mg/kg) will be administered if Numerical rating scale scores are ≥3. IV ondansetron (4 mg) will be given for nausea and vomiting.	Other: Quadro iliac plane block; Patients in Group Q will be placed in the lateral position. A low-frequency convex transducer and a 100-mm block needle will be used. Following sterilization, the transducer will be placed parasagittally at the distal attachment of the quadratus lumborum muscle to the iliac crest. The iliac crest and quadratus lumborum muscle will be visualized, with the erector spinae muscle above and the psoas major muscle below. Using an in-plane technique, the needle will be directed toward the iliac crest. After confirmation with 5 mL of isotonic sodium chloride, 20 mL of 0.25% bupivacaine will be injected incrementally with intermittent aspiration. The same procedure will be applied to the other party. A total of 40 mL of 0.25% bupivacaine will be administered.
Active Comparator: Quadro iliac plane block; All patients will receive IV paracetamol (1 g, 3×1) and IV tenoxicam (20 mg, 2×1). Rescue analgesia (IV tramadol 1 mg/kg) will be administered if Numerical rating scale scores are ≥3. IV ondansetron (4 mg) will be given for nausea and vomiting. Group Q patients will receive quadro iliac plane block in addition to standard analgesia.	Other: Control group; All patients will receive IV paracetamol (1 g, 3×1) and IV tenoxicam (20 mg, 2×1).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The primary outcome is the QoR-15 score (0-150 point) at 24 hours postoperatively.	The primary outcome is the QoR-15 score (0-150 point) at 24 hours postoperatively.	24 hours

Collaborators and Investigators

• Sponsor: Konya City Hospital

Study record dates

Study Major Dates

• Study Start (Actual): March 23, 2025
• Primary Completion (Estimated): June 1, 2026
• Study Completion (Estimated): June 1, 2026

Study Registration Dates

• First Submitted: February 25, 2025
• First Submitted That Met QC Criteria: March 3, 2025
• First Posted (Actual): March 6, 2025

Study Record Updates

• Last Update Posted (Actual): March 11, 2026
• Last Update Submitted That Met QC Criteria: March 8, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain, Postoperative; Investigative Techniques; Epidemiologic Research Design; Epidemiologic Methods; Research Design; Methods; Control Groups
• Other Study ID Numbers: QIPB İnguinal hernia

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No