IINB vs. QLB for Elective Open Inguinal Herniorrhaphy
Condition: Nerve Block; Herniorrhaphy; Regional Anesthesia
Intervention: Ilioinguinal / Iliohypogastric Block; Quadratus Lumborum Block; Bupivacaine 0.25%; Epinephrine 1:200k; Clonidine 1.66mcg/cc
Intervention description: Patients randomized to this arm will receive 25cc's of Bupivacaine 0.25% + Epinephrine 1:200k + Clonidine 1.66mcg/cc administered via an ultrasound guided ilioinguinal / iliohypogastric block technique.; Patients randomized to this arm will receive 25cc's of Bupivacaine 0.25% + Epinephrine 1:200k + Clonidine 1.66mcg/cc administered via an ultrasound guided quadratus lumborum block technique.; Administered as part of the local anesthetic mixture; Administered as part of the local anesthetic mixture; Administered as part of the local anesthetic mixture
Intervention MeSH terms: Clonidine; Epinephrine; Bupivacaine
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Enrollment: 60.0
Sex: All
Minimum age: 18 Years
Maximum age: 90 Years
Healthy volunteers: No

Summary:

      Open inguinal herniorrhaphy is a common outpatient surgical procedure. Post-operative pain
      can be a significant hindrance to discharge from the post anesthesia care unit. Pain can be
      treated with opioid therapy, but the literature supports that these agents are known to
      create or exacerbate adverse effects and complications, including post-operative nausea and
      vomiting, hypoxia, and urinary retention. In contrast, analgesia provided by regional
      anesthesia results in a decreased risk of the aforementioned complications.1 Because of this,
      various regional anesthetic techniques have been developed to provide analgesia following
      open herniorrhaphy. One technique is a combined ilioinguinal and iliohypogastric nerve block
      (IINB), which has been shown to decrease the initial pain after inguinal herniorrhaphy.2 The
      quadratus lumborum block (QLB) is a newer regional anesthetic technique that we think could
      be as effective as IINB at providing pain control following open herniorrhaphy. Additionally,
      because local anesthetic injected during a QLB has the potential to spread cranially into the
      thoracic paravertebral space following its lumbar deposition it could lead to alleviation of
      both somatic and visceral pain.3 This might therefore improve the quality and or duration of
      analgesia as compared to the IINB. To the best of the author's knowledge there has been no
      investigation comparing the efficacy, with regards to post-operative pain management, between
      IINB and QLB.
    

Eligibility criteria:

        Inclusion Criteria:

          -  All patient's scheduled for elective unilateral open inguinal hernia repair at WFUBMC.

        Exclusion Criteria:

          -  The anesthesiologist performing the intraoperative anesthetic deems the patient
             inappropriate for general anesthesia.

          -  If the patient uses more than 40mg of Oxycodone equivalents per 24 hours or is on
             extended release opioid formulations.

          -  If there is a contraindication to the performance of a regional block

          -  Concomitant anticoagulation use

          -  Allergy to local anesthetic

          -  Infectious or dermatologic conditions in the area of block placement that would
             otherwise increase the risk of peripheral nerve blockade

          -  Patient refusal

          -  Pregnancy

          -  Institutionalized individuals

          -  Extremes of age: Age > 90 or < 18

          -  Non English speaking