Açık teknik inguinal herni onarımında adjuvanlı anterior quadratus lumborum bloğun postoperatif analjezik etkinliği: prospektif randomize çift kör çalışma

Abstract

Amaç: Anterior quadratus lumborum blok (QLB), alt abdominal bölgede etkili analjezi sağlayan bir fasyal plan bloğudur. Deksametazonun lokal anesteziklere adjuvan olarak eklendiğinde analjezik etkinliği artırdığı bilinmektedir. Ancak, fasyal plan bloklarında adjuvan olarak kullanımındaki rolü belirsizdir. Bu çalışma, spinal anestezi altında tek taraflı açık teknik inguinal herni onarımı (OIHR) geçiren hastalarda anterior QLB’ye deksametazon eklenmesinin etkisini değerlendirmeyi amaçlamaktadır. Yöntemler: Bu prospektif, randomize, çift kör çalışmaya, tek taraflı OIHR planlanan 67 hasta dahil edildi ve rastgele iki gruba ayrıldı. Her iki gruba da ultrason eşliğinde anterior QLB uygulandı: QLB grubuna standart QLB blok uygulandı (sadece bupivakain) (n=34), A-QLB grubunda (n=33) ise bupivakain ile birlikte deksametazon verildi. Tüm cerrahiler standart mesh tekniği ile gerçekleştirildi. Birincil sonuç 24 saat içinde ilk kurtarıcı analjeziye kadar geçen süreydi. İkincil sonuçlar arasında toplam analjezik tüketimi, istirahat ve dinamik sayısal derecelendirme skala (NRS) skorları ile postoperatif komplikasyonların değerlendirilmesi amaçlandı. Bulgular: Deksametazon eklenmesi, sadece bupivakain kullanımına kıyasla ilk kurtarıcı analjeziye kadar geçen süreyi anlamlı şekilde uzatmadı ve toplam analjezik tüketimini azaltmadı. Ancak, A-QLB grubunda 8., 12. ve 24. saatlerde dinamik NRS skorları, 12. saatte ise istirahat NRS skorları anlamlı derecede daha düşüktü (p<0,05). Her iki grupta da yaklaşık %30 hastada kurtarıcı analjezik gereksinimi oldu. Hiçbir hastada kuadriseps güçsüzlüğü gözlenmedi ve postoperatif bulantı-kusma insidansı gruplar arasında benzerdi. Sonuç: Anterior QLB’ye deksametazon eklenmesi, özellikle hareket sırasında postoperatif ağrı skorlarını iyileştirmiştir. Ancak analjezi süresini uzatmamış veya toplam analjezik tüketimini azaltmamıştır. Bulgular, deksametazonun analjezi kalitesini ve hasta konforunu artırmakla beraber komplikasyon oranlarını değiştirmediğini göstermektedir.

Keywords

• interfasyal deksametazon
• fasyal plan blokları
• postoperatif analjezi
• açık teknik inguinal herni onarımı
• anterior quadratus lumborum blok

Supporting Institution

Sağlık Bilimleri Üniversitesi Gaziosmanpaşa Eğitim ve Araştırma Hastanesi

Project Number

26.04.2023/55

Ethical Statement

Bu çalışma prospektif, randomize, çift kör bir klinik araştırma olarak tasarlandı. Sağlık Bilimleri Üniversitesi Gaziosmanpaşa Eğitim ve Araştırma Hastanesi Klinik Araştırmalar Etik Kurulu’ndan etik onay alındı (onay numarası: 26.04.2023/55). Çalışma ClinicalTrials veritabanına kaydedildi (NCT06664164). Araştırma, 1 Kasım 2024 ile 13 Ağustos 2025 tarihleri arasında Sağlık Bilimleri Üniversitesi Gaziosmanpaşa Eğitim ve Araştırma Hastanesi genel cerrahi ameliyathanelerinde yürütüldü. Tüm uygulamalar Helsinki Bildirgesi ilkelerine uygun şekilde gerçekleştirildi. Çalışmaya katılmadan önce tüm hastalardan yazılı bilgilendirilmiş onam alındı. Çalışma, randomize kontrollü çalışmalar için CONSORT kılavuzuna uygun olarak yürütüldü.

Thanks

Bu çalışmanın istatistiksel analizine sağladığı değerli katkılarından dolayı Ertan Koç’a içten teşekkürlerimizi sunarız.

Postoperative analgesic efficacy of adjuvant anterior quadratus lumborum block in open inguinal hernia repair: a prospective randomized double-blinded study

Abstract

Aims: Anterior quadratus lumborum block (QLB) is a fascial plane block that provides effective analgesia in the lower abdomen. Dexamethasone is known to enhance analgesic efficacy when used as an adjuvant to local anesthetics. However, its role as an adjuvant in fascial plane blocks remains uncertain. This study aimed to evaluate the effect of adding dexamethasone to anterior QLB in patients undergoing unilateral open inguinal hernia repair (OIHR) under spinal anesthesia. Methods: In this prospective, randomized, double-blinded study, 67 patients scheduled for unilateral OIHR were randomly assigned into two groups. Both groups received ultrasound-guided anterior QLB: the QLB group (n=34) received bupivacaine alone, whereas the A-QLB group (n=33) received bupivacaine combined with dexamethasone. All surgeries were performed with a standardized mesh technique. The primary outcome was the time to first rescue analgesia within 24 hours. Secondary outcomes included total analgesic consumption, resting and dynamic numeric rating scale (NRS) scores, and postoperative complications. Results: The addition of dexamethasone did not significantly prolong the time to first rescue analgesia or reduce total analgesic consumption compared with bupivacaine alone. However, the A-QLB group showed significantly lower dynamic NRS scores at 8, 12, and 24 hours and lower resting NRS scores at 12 hours (p<0.05). Approximately 30% of patients in both groups required rescue analgesia. No quadriceps weakness was observed, and the incidence of postoperative nausea and vomiting was similar between groups. Conclusion: The addition of dexamethasone to anterior QLB improved postoperative pain scores, particularly during movement, but did not prolong analgesia duration or reduce total analgesic consumption. These findings suggest that dexamethasone enhances analgesic quality and patient comfort without increasing adverse effects.

Keywords

• Interfascial dexamethasone
• fascial plane blocks
• postoperative analgesia
• anterior quadratus lumborum block
• open inguinal hernia repair

Supporting Institution

Health Sciences University Gaziosmanpaşa Training and Research Hospital

Project Number

26.04.2023/55

Ethical Statement

The present research was structured as a double-blind, randomized, prospective clinical investigation. Ethical approval was obtained from the Health Sciences University Gaziosmanpaşa Training and Research Hospital, Clinical Research Ethics Committee under the registration number 26.04.2023/55, and the study was registered in the Clinical Trials database with the number NCT06664164. Conducted at the general surgery operating room of Health Sciences University Gaziosmanpaşa Training and Research Hospital between November 1, 2024, and Agust 13, 2025, this study adhered to the Declaration of Helsinki and included patients who gave signed informed consent prior to participation and was carried out in accordance with the CONSORT guidelines for randomized controlled trials

Thanks

We would like to express our sincere gratitude to Ertan Koç for his invaluable assistance in the statistical analysis of this study

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