Postoperative Effects of TAP Block Versus QLB Type 2 Block

Study Overview
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Brief Summary
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This study compares analgesic effectiveness of transversus abdominis plane block and quadratus lumborum block type 2 in open hernia repair surgery. All of the patients will receive routine intravenous analgesic regimen. In addition to that one-third of the patients will receive transversus abdominis plane block, one-third will receive quadratus lumborum block type 2. One-third of the patients will not receive any blocks and will constitute the control group

Official Title
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Comparison of Postoperative Analgesic Effects of Transversus Abdominis Plane Block and Quadratus Lumborum Block Type 2

Conditions
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Inguinal Hernia, Postoperative Pain

Intervention / Treatment
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* Drug: Acetaminophen
* Drug: 0.25% Bupivacaine
* Drug: 0.5% Bupivacaine+Glucose
* Drug: Tramadol HCl
* Procedure: Inguinal Hernia Repair
* Drug: 0.25% Bupivacaine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients who are over 18 years of age Patients who are scheduled for elective unilateral open hernia repair with tension free mesh techniques Patients who are in ASA's physical status score group 1 or 2 Exclusion Criteria: Patients who are younger than 18 years of age Patients who have severe stenotic heart diseases Patients who have bleeding diathesis Patients who have true allergies to local anesthetics Patients who have neurologic deficits corresponding to effect site of the anesthetic techniques

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: TAP<br>Patients will undergo inguinal hernia repair under subarachnoid block with 0.5% bupivacaine+glucose. Patients will receive transversus abdominis plane block with 20 ml of 0.25% bupivacaine preoperatively, in addition to intravenous acetaminophen 1000mg twice a day for postoperative analgesia. Tramadol HCl 50mg intramuscular will be provided for salvage analgesia postoperatively. | Drug: Acetaminophen<br>* 1000 mg of intravenous acetaminophen will be administered twice a day<br>* Other names: Postoperative routine analgesia;Drug: 0.25% Bupivacaine<br>* 20 ml of 0.25% bupivacaine will be administered to the fascia of the transversus abdominis muscle under ultrasound guidance.<br>* Other names: Transversus abdominis plane block;Drug: 0.5% Bupivacaine+Glucose<br>* 15mg of 0.5% bupivacaine will be administered to subarachnoid space through 25G spinal needle<br>* Other names: Subarachnoid Block;Drug: Tramadol HCl<br>* 50mg of intramuscular tramadol will be administered when pain score is greater than 3 according to NRS<br>* Other names: Postoperative Salvage Analgesia;Procedure: Inguinal Hernia Repair<br>* Patients will undergo open inguinal hernia repair with one of the tension free mesh techniques<br>|
| Active Comparator: QLB2<br>Patients will undergo inguinal hernia repair under subarachnoid block with 0.5% bupivacaine+glucose. Patients will receive quadratus lumborum type 2 block with 20 ml of %0.25 bupivacaine preoperatively, in addition to intravenous acetaminophen 1000mg twice a day for postoperative analgesia. Tramadol HCl 50mg intramuscular will be provided for salvage analgesia postoperatively. | Drug: Acetaminophen<br>* 1000 mg of intravenous acetaminophen will be administered twice a day<br>* Other names: Postoperative routine analgesia;Drug: 0.5% Bupivacaine+Glucose<br>* 15mg of 0.5% bupivacaine will be administered to subarachnoid space through 25G spinal needle<br>* Other names: Subarachnoid Block;Drug: Tramadol HCl<br>* 50mg of intramuscular tramadol will be administered when pain score is greater than 3 according to NRS<br>* Other names: Postoperative Salvage Analgesia;Procedure: Inguinal Hernia Repair<br>* Patients will undergo open inguinal hernia repair with one of the tension free mesh techniques<br>Drug: 0.25% Bupivacaine<br>* 10 ml 0.25% bupivacaine will be administered quadratus lumborum muscle and erector spinae muscle<br>* Other names: Quadratus lumborum block type 2;|
| Active Comparator: CONT<br>Patients will undergo inguinal hernia repair under subarachnoid block with 0.5% bupivacaine+glucose. Patients will receive intravenous acetaminophen 1000mg twice a day for postoperative analgesia. Tramadol HCl 50mg intramuscular will be provided for salvage analgesia postoperatively. | Drug: Acetaminophen<br>* 1000 mg of intravenous acetaminophen will be administered twice a day<br>* Other names: Postoperative routine analgesia;Drug: 0.5% Bupivacaine+Glucose<br>* 15mg of 0.5% bupivacaine will be administered to subarachnoid space through 25G spinal needle<br>* Other names: Subarachnoid Block;Drug: Tramadol HCl<br>* 50mg of intramuscular tramadol will be administered when pain score is greater than 3 according to NRS<br>* Other names: Postoperative Salvage Analgesia;Procedure: Inguinal Hernia Repair<br>* Patients will undergo open inguinal hernia repair with one of the tension free mesh techniques<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain Intensity | Postoperative pain intensity according Numeric Rating Scale between 0-10 (0=no pain, 10=worst pain ever | 24 hours after surgery | 
| Pain Intensity | Postoperative pain intensity according Numeric Rating Scale between 0-10 (0=no pain, 10=worst pain ever) | 2 hours after surgery | 
| Pain Intensity | Postoperative pain intensity according Numeric Rating Scale between 0-10 (0=no pain, 10=worst pain ever | 6 hours after surgery | 
| Pain Intensity | Postoperative pain intensity according Numeric Rating Scale between 0-10 (0=no pain, 10=worst pain ever | 48 hours after surgery |