The primary objective of this study is to evaluate and compare the efficacy of different volumes of local anesthetics, administered at the same total dose, for ilioinguinal and iliohypogastric (II/IH) nerve blocks in patients undergoing unilateral inguinal hernia repair.
The investigators aim to determine whether varying the injectate volume-while keeping the total drug amount constant-influences the quality and duration of postoperative analgesia. By monitoring pain scores and opioid consumption, this research seeks to identify the optimal volume-to-dose ratio for enhancing patient recovery and pain management following inguinal surgery.
Patients aged between 18 and 75 years
American Society of Anesthesiologists (ASA) physical status I, II, or III
Diagnosis of unilateral inguinal hernia
Scheduled for elective open inguinal hernia repair under spinal anesthesia
Age under 18 or over 75 years
ASA physical status IV or higher
Body mass index (BMI) greater than 35 kg/m²
Pregnancy or suspected pregnancy
Parallel
Bupivacaine (Ilioinguinal-iliohypogastric nerve block)
Drug"Participants are randomized into two intervention groups to receive ultrasound-guided ilioinguinal-iliohypogastric nerve blocks with a fixed total dose of 37.5 mg bupivacaine. Group 1 (Low Volume): Receives 10 mL of 0.375% bupivacaine. Group 2 (High Volume): Receives 20 mL of 0.1875% bupivacaine. The procedure is performed using a high-frequency linear ultrasound probe. After the identification of the ilioinguinal and iliohypogastric nerves between the internal oblique and transversus abdominis muscles, the specified volume of local anesthetic is injected. All patients undergo the same surgical procedure (unilateral inguinal hernia repair) under spinal anesthesia. The primary focus is to evaluate the impact of local anesthetic volume on the duration and quality of postoperative analgesia."
Time to first rescue analgesic requirement.
The time elapsed (measured in hours) from the completion of the ilioinguinal-iliohypogastric nerve block until the patient first requests or requires supplemental (rescue) analgesic medication due to a Visual Analog Scale (VAS) score of $\\ge 4$. This reflects the effective duration of the sensory block provided by the local anesthetic.
Postoperative Pain Intensity
Pain intensity will be assessed using the Visual Analog Scale (VAS) at rest and during movement. The scale ranges from 0 (no pain) to 10 (the worst imaginable pain)
Total Analgesic Consumption
The total cumulative dose of supplemental rescue analgesic medication (such as paracetamol or tramadol) consumed by the patient, measured in milligrams. This measures the opioid-spar
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