Comparing the effects of local anesthetic infiltration and different fascial plane blocks on postoperative quality of recovery and pain in inguinal hernia repair

In our study, we aimed to compare the effects of regional analgesia techniques such as local anesthetic infiltration, TAP block and KLB-3, which are applied as components of multimodal analgesia in inguinal hernia surgeries, primarily on the quality of recovery of patients and secondarily on postoperative acute and chronic pain levels. In this prospectively planned randomized study, 90 patients aged 18-70 years with American Society of Anesthesiologists (ASA) classification I-III, undergoing unilateral open inguinal hernia repair, were included. Patients completed QoR-15 preoperatively, and after sedoanalgesia, Group L received local infiltration, Group K received anterior KLB under ultrasound guidance, and Group T received TAP block with 20 mL of 0.25% bupivacaine. General anesthesia was administered, and anesthesia maintenance was provided with 2-2.5% sevoflurane and remifentanil infusion. At the end of the surgery, patients received intravenous paracetamol. Postoperative pain levels were assessed with the NRS, and if NRS ≥4, additional analgesic iv ibuprofen was administered. The QoR-15 was re-administered at 24 hours after surgery and possible side effects were recorded. Patients were evaluated for chronic pain 3 months postoperatively using NRS and DN-4 questionnaire.The effects of the three different applications on patients' recovery quality were similar. Group L had the highest intraoperative remifentanil consumption. While no difference was found between Group T and K in terms of postoperative pain scores, Group L had higher scores. It was observed that additional analgesic consumption was higher in Group L, but the time to the first analgesic request was similar between the groups. Perioperative hemodynamic values and side effects were similar among the groups. Postoperative pain scores and DN-4 results were similar in patients 3 months later. In conclusion, although there was no difference in postoperative recovery quality, TAP block and KLB, as part of multimodal analgesia in unilateral inguinal hernias, provide longer-lasting and more effective analgesia compared to local anesthetic infiltration.