Comparison of The Quadratus Lumborum Block and Ilioinguinal Iliohypogastric Nerve Block
Condition: Post Operative Pain; Inguinal Hernia; Quadratus Lumborum Nerve Block
MeSH terms: Hernia; Pain, Postoperative; Hernia, Inguinal
Study type: Interventional

Summary: 
      Perioperative and postoperative pain control in pediatric patients is a frequently neglected
      issue. Regional anesthesia applications reduce adverse drug events by minimizing opioid
      consumption and provide effective and safe analgesia. In recent years, quadratus lumborum
      block has emerged as an alternative regional anesthesia technique and it has been shown to
      provide analgesia as effectively as caudal block in children, and in a limited number of
      studies it has been said that it is more effective than transversus abdominis plane block.
      There are few studies in the literature comparing ilioinguinal iliohypogastic nerve block and
      quadratus lumborum block in children.
    

Detailed description: 
      Perioperative and postoperative pain control in pediatric patients is a frequently neglected
      issue. Providing effective perioperative analgesia reduces surgical stress, making the
      postoperative period more comfortable both physiologically and psychologically, effective
      postoperative pain control reduces the length of stay in the hospital, and also contributes
      to the long-term positive personality development of children.

      Physiological, pharmacokinetic and pharmacodynamic differences in children delay the
      metabolism and excretion of systemic analgesics, resulting in a prolonged effect and an
      increased risk of apnea. Regional anesthesia applications reduce adverse drug events by
      minimizing opioid consumption and provide effective and safe analgesia.

      Caudal block, which is a common regional anesthesia practice in inguinal hernia surgery in
      children, has disadvantages such as motor block and urinary retention. With the introduction
      of ultrasonography, peripheral block techniques such as transversus abdominis plane block and
      ilioinguinal iliohypogastric nerve block have been shown to provide effective and safe
      analgesia and have replaced central blocks. In recent years, quadratus lumborum block has
      emerged as an alternative regional anesthesia technique and it has been shown to provide
      analgesia as effectively as caudal block in children, and in a limited number of studies it
      has been said that it is more effective than transversus abdominis plane block. There are few
      studies in the literature comparing ilioinguinal iliohypogastric nerve block and quadratus
      lumborum block in children.

      The purpose of the study to compare the postoperative analgesic effectiveness of quadratus
      lumborum block and ilioinguinal iliohypogastric block in pediatric patients who underwent
      unilateral inguinal hernia operation.
    

Intervention name(s): ultrasound-guided quadratus lumborum nerve block; ultrasound-guided Ilioinguinal Iliohypogastric Nerve Block
Intervention type(s): Procedure; Procedure
Intervention description(s): The patient was placed in the lateral position with the side to be blocked on top. After providing skin antisepsis with 5% povidone iodine, sterile dressing was applied. After the USG probe was covered with a sterile sheath, it was placed transversely between the iliac crest and the costa edge. After imaging the external-internal oblique and transversus abdominis muscles, the probe was advanced posteriorly. Quadratus lumborum, Psoas Major and Erector Spina muscles were visualized. The needle was advanced towards the middle thoracolumbar fascia between the Quadratus lumborum muscle and the Erector Spina muscle with the in-plane technique, and the location was confirmed by injecting 1 ml of 0.9 saline. 0.25% Bupivacaine was injected at a dose of 0.5 mL/kg after negative aspiration.; The patient was placed in the supine position. After providing skin antisepsis with 5% povidone iodine, sterile dressing was applied. After the USG probe was covered with a sterile sheath, it was placed on the anterior abdominal wall parallel to the imaginary line between the umbilicus and the anterior superior iliac wing. After imaging the external-internal oblique and transversus abdominis muscles, the ilioinguinal-iliohypogastric nerve was visualized as two small hypoechoic areas between the internal oblique muscle and the transversus abdominis muscle. The location was confirmed by injecting 1 ml of 0.9 saline by advancing the needle with the in-plane technique close to the nerve structures. 0.25% Bupivacaine was injected at a dose of 0.5 mL/kg after negative aspiration.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: quadratus lumborum nerve block; postoperative pain; inguinal herniae; ilio-inguinal iliohypogastric nerve block