Comparison of anterior, posterior, and lateral approaches of ultrasound-guided quadratus lumborum block in an adult patient undergoing inguinal hernia surgery: A prospective randomized controlled trial

Abstract Background and Aims: Inguinal hernia surgeries can pose significant postoperative pain, leading to chronic pain syndromes when not managed well. Material and Methods: Sixty American Society of Anesthesiologists (ASA) I/II adult patients scheduled to undergo unilateral inguinal hernia surgeries were enrolled in this trial. The patients were randomly allocated into three groups according to the various approaches of ultrasound-guided quadratus lumborum (QL) block: group transmuscular (TM): TM or anterior approach, group L: lateral approach, and group P: posterior approach. All the patients underwent surgery under subarachnoid blockade. A QL block was administered at the end of the surgery. Results: A total of 19 patients in each group were analyzed. Patients in the TM group had the least 24-hour requirement of fentanyl (P < 0.001), with better pain scores (P < 0.001) and prolonged duration of analgesia. No significant difference was found in the patient satisfaction scores (PSSs) in the three approaches. None of the patients reported any adverse effects related to the block. Conclusion: The TM approach of QL block is an effective analgesic strategy in patients undergoing unilateral hernia surgeries. It could form a part of the multimodal analgesic regimen for such patients.