Analgesic Efficacy of Erector Spinae Plane Block for Laparoscopic Inguinal Hernia Repair
Condition: Postoperative Pain
MeSH terms: Pain, Postoperative; Hernia; Hernia, Inguinal
Study type: Interventional

Summary: 
      Postoperative analgesia management in inguinal hernia surgery is difficult because of the
      content of the surgical procedure. A multimodal approach to postoperative analgesia has
      recently been proposed. For this reason, various methods are used.Regional blocks,
      pharmacological treatments are among these methods. Among the regional blocks, ilioinguinal
      and hypogastric blocks are used more safely and with increasing frequency, especially with
      the introduction of ultrasonography in the clinic.Forero et al. firstly, erector spinae block
      which was used for the first time in the treatment of thoracic neuropathic pain has been
      widely used especially in laparoscopic abdominal surgery and it has taken its place in the
      literature. It is performed at T4-5 level in breast and thoracic surgery and T7 level in
      abdominal surgery. In this block, local anesthesia between the erector spina muscle and the
      transverse protrusion of the vertebra was used to create analgesia in the anterior abdominal
      wall.

      In this study, we planned to investigate degree of postoperative pain, sensory block levels,
      analgesic consumption, propofol-remifentanyle consumption and side effects of patients
      undergoing inguinal hernia surgery under general anesthesia with erector spinae block.
    

Detailed description: 
      Patients in the ASA 1-3 group who underwent laparoscopic inguinal hernia surgery, underwent
      erector spina block and operated under general anesthesia, will be included in the study.
      Approximately 50 patients will participate in the study, the number of patients will be
      finalized by power analysis.

      The routine algorithm for patients undergoing elective laparoscopic inguinal hernia surgery
      is a multimodal approach including induction of general anesthesia for postoperative
      analgesia followed by peripheral nerve block and 50 mg of dexketoprofen trometamol. Before
      the block, all patients were monitored by standard monitoring and intravenous vascular access
      was opened. When applying the erector spinae block, the patient is placed in the lateral
      decubitus position. After the C7 spinous protrusion is prepared as sterile as T10, the
      erector spina muscle is seen at the T7 level on the same side as the hernia with the convex
      probe and block is applied with 0.25% bupivacaine (20 cc). In the control group, there were
      no intervention except local anesthetic infiltration to the trochar sites. Sensory block was
      evaluated by cold stimulus (0 = no cold sensation, 1 = cold sensation severely reduced, 2 =
      cold sensation slightly decreased, 3 = normal cold sensation). In anesthesia induction,
      propofol 2-4 mg / kg, fentanyl 1-2 mcq / kg, lidocaine 1mg / kg and rocuronium 0.6 mg / kg
      are routinely administered to all patients. Patients were treated with inhalation of oxygen
      and air mixture during surgery, and anesthesia was maintained using remifentanil 0.05-0.1
      mcg/kg/min and propofol 80-100 mcg/kg/min via total intravenous micro pump until the surgery
      was completed. Postoperative analgesic needs of the patients will be recorded from the
      information in the current patient controlled analgesia device. All patients' postoperative
      pain numerical rating scale (NRS-numeric rating scale; 0 = absence of pain, 10 = unbearable
      pain) will be recorded.
    

Intervention name(s): Erector Spina Block
Intervention type(s): Procedure
Intervention description(s): After the C7 spinous protrusion is prepared as sterile as T10, the erector spina muscle is seen at the T7 level on the same side as the hernia with the convex probe and block is applied with 0.25% bupivacaine (20 cc).
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: One group will receive erector spinae plane block, and the other will receive nothing
Masking: Single (Participant)
Primary purpose: Prevention
Keywords: Laparoscopic inguinal hernia surgery,; postoperative pain