Comparison of QLB and TFP Block for Postoperative Analgesia in Laparoscopic Inguinal Hernia

Laparoscopic inguinal hernia repair is a standard, minimally invasive procedure. However, moderate pain is common in the first 24 hours postoperatively, originating from somatic pain at trocar sites and visceral pain from peritoneal irritation and mesh placement. Multimodal analgesia, including fascial plane blocks, is recommended to reduce opioid consumption and improve pain control.

In this prospective, randomized, controlled, single-center trial, 90 patients (ASA I-III, aged 18-65) scheduled for elective laparoscopic inguinal hernia repair under general anesthesia will be allocated into three parallel arms (n=30 each) via computer-based randomization.

Group QLB: Will receive bilateral ultrasound-guided lateral Quadratus Lumborum Block (total 40 mL 0.25% bupivacaine) prior to extubation, along with 10 mL 0.25% bupivacaine infiltration at port sites.

Group TFP: Will receive bilateral ultrasound-guided Transversalis Fascia Plane Block (total 40 mL 0.25% bupivacaine) prior to extubation, along with 10 mL 0.25% bupivacaine infiltration at port sites.

Group Control: Will receive only port site infiltration (total 20 mL 0.25% bupivacaine).

All procedures will be performed aseptically by the same surgical and anesthesia team. Postoperatively, all patients will receive 1 g intravenous paracetamol every 8 hours. Postoperative pain will be assessed using the Numeric Rating Scale (NRS) by an anesthesiologist blinded to the group allocation. Intravenous tramadol (100 mg) will be administered as rescue analgesia if the NRS score is ≥ 4. Total 24-hour tramadol consumption, along with block-related complications and opioid-related side effects (nausea, vomiting, sedation), will be recorded.

• Lateral Quadratus Lumborum Block (Procedure): Bilateral ultrasound-guided lateral QLB with 20 mL of 0.25% bupivacaine per side (total 40 mL). Plus, 10 mL of 0.25% bupivacaine infiltration at trocar insertion sites.
• Transversalis Fascia Plane Block (Procedure): Bilateral ultrasound-guided TFP block with 20 mL of 0.25% bupivacaine per side (total 40 mL). Plus, 10 mL of 0.25% bupivacaine infiltration at trocar insertion sites.
• Port Site Infiltration (Procedure): Local infiltration of 20 mL of 0.25% bupivacaine at the trocar insertion sites.

Primary outcomes

• Numeric Rating Scale (NRS) Pain Score [At 0, 3, 6, 12, 18, and 24 hours postoperatively.]: Postoperative pain intensity assessed using the Numeric Rating Scale (NRS). The scale ranges from 0 to 10, where 0 indicates "no pain" and 10 indicates "worst imaginable pain". Higher scores represent worse pain outcomes.

Secondary outcomes

• Total Tramadol Consumption [During the first 24 hours postoperatively.]: The cumulative dose of intravenous tramadol (in milligrams) administered as rescue analgesia.
• Need for Rescue Analgesia [During the first 24 hours postoperatively]: The number of patients requiring rescue analgesia (tramadol 100 mg IV) when the NRS score is ≥ 4.
• Incidence of Opioid-Related Side Effects [During the first 24 hours postoperatively.]: The number of patients experiencing postoperative nausea, vomiting, or sedation.
• Incidence of Block-Related Complications [During the first 24 hours postoperatively.]: The number of patients experiencing complications related to the regional block application, such as hematoma, infection, or local anesthetic systemic toxicity (LAST).

Sex: All, ages: 18 Years to 65 Years

Inclusion Criteria:

* Scheduled for elective laparoscopic inguinal hernia repair.
* American Society of Anesthesiologists (ASA) physical status I, II, or III.
* Age between 18 and 65 years.
* Provided written informed consent.

Exclusion Criteria:

* History of allergy to local anesthetics.
* Presence of coagulopathy.
* Signs of infection at the intended block application site.
* Body Mass Index (BMI) ≥ 35 kg/m².
* History of chronic opioid use.
* Presence of neurological disease.
* Refusal to participate in the study.