Background: Quadratus lumborum block (QLB) has been reported as an innovative analgesic procedure for enhanced recovery after inguinal herniorrhaphy. However, it has never been compared with local infiltration anesthesia (LIA) as the sole anesthetic technique in inguinal herniorrhaphy. This study aimed to compare the anesthetic efficacy of QLB and LIA for inguinal herniorrhaphy. Methods: A total of 70 patients undergoing elective inguinal herniorrhaphy were randomly assigned to receive either QLB or LIA. The primary outcome was the area under the curve (AUC) of the pain numeric rating scale (NRS) during surgery. Secondary outcomes included anesthesia efficacy, consumption of additional local anesthetics for rescue analgesia, level of intraoperative traction reaction, postoperative pain scores at rest and during movement, and adverse side effects. Results: The QLB group had a significantly higher AUC for intraoperative NRS scores than the LIA group (15.7 ± 3.1 vs 13.1 ± 3.6, 95% CI for the difference: 1.23 to 4.17, P=0.002) and required a greater volume of rescue local anesthetics (11.0 ± 7.6 mL vs. 5.7 ± 6.4 mL, 95% CI for the difference: 1.05 to 9.55, P=0.02). However, the QLB group had lower scores for visceral traction reaction median 2.0 (interquartile range, IQR 2.0 to 2.3) vs. 2.0 (IQR 2.0 to 3.0), 95% CI for the median difference: -0.82 to -0.05, P=0.026 and lower resting NRS pain scores at 12 h postoperatively. Conclusions: Both QLB and LIA can provide sufficient analgesia for inguinal herniorrhaphy without the need for conversion to other anesthetic methods. LIA is more effective in controlling intraoperative pain and reducing the consumption of rescue local anesthetics, while QLB is associated with milder peritoneal traction reaction and better postoperative analgesia at 12 h after surgery. The combination of LIA and QLB is hypothesized to be a more optimal anesthetic choice for inguinal herniorrhaphy, which requires further prospective clinical research to verify this assumption.
Yong Liu (Tue,) studied this question.