Ultrasound-Guided Transversalis Fascia Plane Block Versus Transmuscular Quadratus Lumborum Block for Post-operative Analgesia in Inguinal Hernia Repair
Pain Management of Inguinal Herniorrhaphy
About this trial
This is an interventional treatment trial for Pain Management of Inguinal Herniorrhaphy focused on measuring ultrasound guided regional blocks, Transversalis Fascia Plane Block, Quadratus Lumborum Block, inguinal herniorrhaphy, Pain management
Eligibility Criteria
Inclusion Criteria:
- All consecutive patients of ASA classification grade I and II,
- aged above 18 years old and less than 65 years old,
- of both sexes,
- body mass index (BMI) below 35,
- who had a capacity to rate pain on a numeric rating scale (NRS) of 0 to --underwent non-recurrent unilateral inguinal hernia repair
Exclusion Criteria:
- patient refusal
- patient aged < 18 or > 65 years old,
- ASA classification > II, BMI < 35
- those with previous difficulty in evaluating their level of pain
- any contraindications for local anesthesia as: patient refusal of local anesthesia injection, coagulopathy( defined as either thrombocytopenia (platelet count below 100,000 platelets per microliter and/or prothrombin time greater than 14 seconds ), therapeutic anticoagulation, presence of skin infection or hematoma in the vicinity of the puncture site or those with known allergy to any of the study drugs
Sites / Locations
- Hany Mohammed El-Hadi Shoukat Mohammed
Arms of the Study
Arm 1
Arm 2
Active Comparator
Active Comparator
QL group (n = 25)
TF group (n = 25)
After general anesthesia (GA), patient will be placed in lateral position with side to be anesthetised upwards. U/S probe will be placed in the transverse plane at the abdominal flank immediately cranial to the iliac crest. Then moved dorsally until the QL muscle is identified with its attachment to lateral edge of the transverse process of the L4 vertebral body with identification of shamrock sign. The needle is inserted in-plane to transducer (lateral edge) and tip of needle is advanced through the QL muscle. Once the tip of the needle correctly placed and confirmed by negative aspiration, 2 ml of normal saline will be instilled to confirm correct separation of the plane. Following this, 30 ml of 0.25% bupivacaine will be injected between the QL and psoas major.
After GA, patient will be placed in lateral position with side to be anesthetised upwards. U/S probe will be placed in midaxillary line just cephalad to the iliac crest. Scanning anteriorly will identify the three muscles of the anterior abdominal wall. The transversus abdominis typically tapers to form a hyper echoic aponeurosis that passes posterior to quadratus lumborum. Scan will be continued posteriorly to visualize solid organs or viscera deep to the transversus abdominis. The needle will be positioned such that it enters the skin anterior to the ultrasound probe and passes in-plane posterolateral through the three lateral abdominal muscles. Once the tip of the needle correctly placed and confirmed by negative aspiration, 2 ml of normal saline will be instilled to confirm correct separation of the plane. Following this, 30 ml of 0.25% bupivacaine will be injected between the transversus abdominis muscle and the transversalis fascia anterolateral to quadratus lumborum.