Impact of Erector Spinae Plane Block on Quality of Recovery and Time to Return to Daily Activities After Open Inguinal Hernia Repair: a Randomized Controlled Trial

Background Erector spinae plane block (ESPB) has emerged as a component of multimodal analgesia for abdominal surgery; however, its effect on patient-centered recovery after open inguinal hernia repair remains unclear. This randomized controlled trial evaluated whether ESPB improves postoperative quality of recovery following unilateral open Lichtenstein inguinal hernia repair under spinal anesthesia. Methods Sixty adult patients undergoing elective unilateral Lichtenstein inguinal hernia repair under spinal anesthesia were randomized to receive ultrasound-guided ESPB (n = 30) or no regional block (control, n = 30). The primary outcome was the postoperative 24-hour Quality of Recovery-15 Turkish version (QoR-15T) score. Secondary outcomes included acute pain scores at rest and during movement, opioid consumption, and time to return to normal daily activities. Results Baseline QoR-15T scores were comparable between groups. At 24 hours, QoR-15T scores were higher in the ESPB group than in controls (131.9 ± 8.5 vs. 119.5 ± 11.2; mean difference − 12.43, 95% CI − 17.57 to − 7.30; p < 0.001). Pain scores were similar during the first 2 postoperative hours. Movement pain was lower with ESPB at 6 hours (mean difference 1.50, 95% CI 0.42–2.58) and 24 hours (mean difference 0.90, 95% CI 0.32–1.48). Resting pain was lower only at 24 hours (mean difference 0.60, 95% CI 0.002–1.20). ESPB reduced rescue tramadol requirements (p = 0.003) and shortened time to return to normal daily activities (6.2 ± 3.7 vs. 10.3 ± 4.6 days; p < 0.001). Conclusions In patients undergoing open Lichtenstein inguinal hernia repair under spinal anesthesia, ESPB significantly improved postoperative quality of recovery, reduced postoperative pain during the late recovery period, decreased rescue opioid requirements, and accelerated return to normal daily activities. Trial registration The trial was prospectively registered on ClinicalTrials.gov (NCT07509957) on March 23, 2026.