Ultrasound-Guided Ilioinguinal-Iliohypogastric Nerve Block Following Spinal Anesthesia Comparing Dexmedetomidine Versus Nalbuphine as Adjuvants to Bupivacaine in Unilateral Inguinal Hernia Repair
Ultrasound-Guided Ilioinguinal-Iliohypogastric Nerve Block Following Spinal Anesthesia Comparing Dexmedetomidine Versus Nalbuphine as Adjuvants to Bupivacaine in Unilateral Inguinal Hernia Repair: A Prospective, Randomized, Double-Blind Controlled Study
This study evaluates and compares the pain-relieving efficacy and safety of adding either dexmedetomidine or nalbuphine to bupivacaine in an ultrasound-guided ilioinguinal-iliohypogastric nerve block for patients undergoing elective unilateral inguinal hernia repair under spinal anesthesia.
While spinal anesthesia provides effective surgical anesthesia, postoperative pain often increases as the block recedes. Supplementing spinal anesthesia with an ultrasound-guided peripheral nerve block targeting the ilioinguinal and iliohypogastric nerves provides localized pain relief. Adding adjuvant medications to the local anesthetic may extend the duration of pain control and reduce systemic analgesic requirements.
Participants are randomly allocated to one of three groups:
- Control Group: Receives bupivacaine with normal saline.
- Nalbuphine Group: Receives bupivacaine combined with nalbuphine.
- Dexmedetomidine Group: Receives bupivacaine combined with dexmedetomidine.
The primary objective is to assess the duration of analgesia by measuring the time from the regression of spinal sensory anesthesia until the first request for rescue pain medication. Secondary objectives include evaluating total 24-hour pain medication consumption, postoperative pain scores, vital signs, sedation scores, patient satisfaction, and side effects.
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Fase
Fase
- Fase 4
Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inclusion Criteria:
- Age 18 to 65 years
- American Society of Anesthesiologists (ASA) physical status I or II
- Scheduled for elective unilateral primary inguinal hernia repair under spinal anesthesia supplemented with ilioinguinal-iliohypogastric nerve block
- Body weight between 45 and 100 kg and body mass index (BMI) <= 35 kg/m^2
- Ability to understand the study protocol, comply with study requirements, and communicate pain intensity using the Visual Analog Scale (VAS)
Exclusion Criteria:
- Known allergy or hypersensitivity to amide-type local anesthetics, dexmedetomidine, or nalbuphine
- Contraindications to spinal anesthesia (e.g., severe hypovolemia, elevated intracranial pressure, active infection at the lumbar puncture site, severe spinal deformity)
- History of neurological disorders (e.g., peripheral neuropathy, myopathy, seizure disorders, or cognitive impairment)
- Coagulopathy, concurrent anticoagulant therapy, or local infection at the block site contraindicating regional anesthesia
- Severe hepatic, renal, or cardiovascular disease (e.g., heart block, uncontrolled hypertension, ischemic heart disease, severe valvular disease, chronic renal failure, or liver cirrhosis)
- History of opioid or substance abuse
- Emergency surgical procedures
- Procedures expected to exceed 3 hours or requiring conversion to general anesthesia
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Firedobbelt
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
|
Aktiv komparator: Group C: Bupivacaine Control
Patients undergo ultrasound-guided ilioinguinal-iliohypogastric nerve block immediately following spinal anesthesia with a total injectate volume of 10 mL consisting of 8 mL 0.5% bupivacaine (40 mg) and 2 mL sterile normal saline (final bupivacaine concentration 0.4%). |
Single-injection ultrasound-guided ilioinguinal-iliohypogastric (IIIH) nerve block administered immediately after spinal anesthesia. The injectate consists of 8 mL 0.5% bupivacaine (40 mg) combined with 2 mL sterile 0.9% normal saline to achieve a total volume of 10 mL (final bupivacaine concentration 0.4%). |
|
Eksperimentel: Group N: Nalbuphine Adjuvant
Patients undergo ultrasound-guided ilioinguinal-iliohypogastric nerve block immediately following spinal anesthesia with a total injectate volume of 10 mL consisting of 8 mL 0.5% bupivacaine (40 mg) and nalbuphine 10 mg diluted with sterile normal saline to 10 mL (final bupivacaine concentration 0.4%). |
Single-injection ultrasound-guided ilioinguinal-iliohypogastric (IIIH) nerve block administered immediately after spinal anesthesia. The injectate consists of 8 mL 0.5% bupivacaine (40 mg) combined with 2 mL sterile 0.9% normal saline to achieve a total volume of 10 mL (final bupivacaine concentration 0.4%). Single-injection ultrasound-guided ilioinguinal-iliohypogastric (IIIH) nerve block administered immediately after spinal anesthesia. The injectate consists of 8 mL 0.5% bupivacaine (40 mg) combined with nalbuphine 10 mg, diluted with sterile 0.9% normal saline to achieve a total volume of 10 mL (final bupivacaine concentration 0.4%). |
|
Eksperimentel: Group D: Dexmedetomidine Adjuvant
Patients undergo ultrasound-guided ilioinguinal-iliohypogastric nerve block immediately following spinal anesthesia with a total injectate volume of 10 mL consisting of 8 mL 0.5% bupivacaine (40 mg) and dexmedetomidine 1 µg/kg diluted with sterile normal saline to 10 mL (final bupivacaine concentration 0.4%). |
Single-injection ultrasound-guided ilioinguinal-iliohypogastric (IIIH) nerve block administered immediately after spinal anesthesia. The injectate consists of 8 mL 0.5% bupivacaine (40 mg) combined with 2 mL sterile 0.9% normal saline to achieve a total volume of 10 mL (final bupivacaine concentration 0.4%). Single-injection ultrasound-guided ilioinguinal-iliohypogastric (IIIH) nerve block administered immediately after spinal anesthesia. The injectate consists of 8 mL 0.5% bupivacaine (40 mg) combined with dexmedetomidine 1 µg/kg, diluted with sterile 0.9% normal saline to achieve a total volume of 10 mL (final bupivacaine concentration 0.4%). |
Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Time to First Rescue Analgesia
Tidsramme: Up to 24 hours postoperatively
|
Time in minutes from the documented regression of spinal sensory block to the T12 dermatome until the patient's first request for rescue analgesia, administered when the Visual Analog Scale (VAS) pain score is 4 or greater (scale of 0 = no pain to 10 = worst imaginable pain). |
Up to 24 hours postoperatively
|
Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Datoer for undersøgelser
Studer store datoer
Studiestart (Anslået)
Studiestart
Primær færdiggørelse (Anslået)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Nøgleord
Yderligere relevante MeSH-vilkår
- Smerte
- Neurologiske manifestationer
- Postoperative komplikationer
- Patologiske processer
- Patologiske Tilstande, Anatomiske
- Brok
- Brok, Abdominal
- Patologiske tilstande, tegn og symptomer
- Tegn og symptomer
- Smerter, postoperativ
- Brok, lyskebrok
- Organiske kemikalier
- Heterocykliske forbindelser, 1-ring
- Heterocykliske forbindelser
- Heterocykliske forbindelser, smeltet ring
- Azoler
- Alkaloider
- Polycykliske aromatiske kulbrinter
- Polycykliske forbindelser
- Imidazoler
- Anilider
- Amider
- Anilinforbindelser
- Aminer
- Heterocykliske forbindelser, 4 eller flere ringe
- Morfinans
- Opiatalkaloider
- Heterocykliske forbindelser, bro-ring
- Fenanthrener
- Bupivacain
- Dexmedetomidin
- Nalbufin
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- Dex vs Nalbuphine: Nerve Block
Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter
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