Comparison of postoperative analgesic effectiveness of ultrasound-guided ilioinguinal-iliohypogastric block, transversus abdominis plane block, and quadratus lumborum block in inguinal hernia surgeries

Inguinal hernia, especially common in males, is frequently detected and is one of the primary reasons for lower abdominal surgeries. The development of postoperative acute pain, especially its transformation into chronic pain, is a significant issue in the postoperative period. This study aims to effectively implement postoperative analgesia in patients undergoing inguinal hernia surgery under spinal anesthesia, prevent the chronicization of pain, reduce pain scores, and decrease opioid-related side effects. Eighty patients between the ages of 18 and 75, classified as ASA class 1 and 2, who underwent unilateral inguinal hernia surgery were included in the study. The patients were divided into four groups: those who applied ilioinguinal-iliohypogastric block after spinal anesthesia, those who applied TAP block, those who applied QLB and a control group. Blocks in all three groups were administered using 20 mL of %0,25 bupivacaine during the preoperative period. All patients received spinal anesthesia for surgery using 15 mg of %0,5 hyperbaric bupivacaine, and patient-controlled analgesia (PCA) with tramadol was applied postoperatively (prepared by adding 300 mg tramadol to 100 mL isotonic serum to achieve a concentration of 3 mg/cc, with an infusion rate of 3 mL/hour, a bolus dose of 5 mL, a lockout time of 4 hours, and a total duration of 24 hours). Despite the administration of tramadol bolus via PCA, IV paracetamol was administered as additional analgesia when the resting visual analog scale (VAS) score was >4. As measurements, VAS scores at rest and during movement in the postoperative care unit (PACU) at 1, 2, 6, 12, and 24 hours, the presence of side effects such as nausea and vomiting related to opioid use, the total amount of tramadol bolus and infusion administered, and the amount of paracetamol administered as additional analgesia were used. Compared to the control group, VAS scores, total tramadol consumption in the first 24 hours postoperatively, side effects related to opioid use, and the need for additional analgesia were found to be lower on average in the ilioinguinal-iliohypogastric block, TAP block, and QLB groups, but these differences were not statistically significant. In the ilioinguinal-iliohypogastric block group, average VAS scores and the need for additional analgesia were lower compared to the TAP block and QLB groups, but this difference was also not statistically significant. In our study, we observed that the ilioinguinal-iliohypogastric block, applied under ultrasound guidance as part of multimodal analgesia, kept VAS scores low in patients undergoing inguinal hernia surgery with spinal anesthesia compared to TAP block and QLB. We also observed that all three blocks improved the quality of analgesia and increased patient comfort. In conclusion, we found that all three blocks improved the quality of spinal anesthesia and were deemed feasible for use. Keywords: Inguinal hernia; Ilioinguinal-iliohypogastric block; Transversus abdominis plane block; Quadratus lumborum block