This randomized clinical trial aims to evaluate and compare the analgesic efficacy of the Transversalis Fascia Plane Block (TFPB) and the Modified Thoracoabdominal Nerve Block through Perichondrial Approach (M-TAPA) in patients undergoing laparoscopic inguinal hernia repair. The primary outcome is the Visual Analog Scale (VAS) score within the first 24 hours after surgery. Secondary outcomes include total opioid consumption, requirement for rescue analgesia, block-related complications and adverse effects (hematoma, local anesthetic systemic complications, vascular puncture, and infection), patient satisfaction assessed using a Likert scale, quality of recovery assessed using the QoR-15 questionnaire, and incidence of postoperative nausea and vomiting.
Patients aged 18-65 years
ASA physical status I-III
Scheduled for elective laparoscopic inguinal hernia repair
Body mass index (BMI) 18-35 kg/m²
Refusal to participate
Allergy to local anesthetics
Infection at the injection site
Coagulopathy or ongoing anticoagulant therapy
Parallel
Transversalis Fascia Plane Block
Procedure/SurgeryA high-frequency linear ultrasound probe will be positioned transversely above the iliac crest along the midaxillary line.Anatomical landmarks, including the external oblique muscle, internal oblique muscle, transversus abdominis muscle, and transversalis fascia will be identified. Using an in-plane approach, a 21 G 0.8×100 mm echogenic insulated needle will be advanced through the muscular layers toward the plane between the transversus abdominis muscle and the transversalis fascia.Proper needle placement will be confirmed with the injection of 1-2 mL isotonic saline demonstrating hydrodissection within the transversalis fascia plane. Upon confirmation and negative aspiration, 20 mL of 0.25% bupivacaine hydrochloride will be administered on each side under ultrasound guidance.
M TAPA block
Procedure/SurgeryA linear ultrasound probe will be positioned obliquely along the costal margin at the level of the 10th costal cartilage. Anatomical landmarks, including the costal cartilage, rectus abdominis muscle, transversus abdominis muscle, and internal oblique muscle will be identified. Using an in-plane approach, a 21G 0.8×100 mm echogenic insulated needle will be inserted toward the perichondrial plane beneath the 10th costal cartilage under ultrasound guidance. Proper needle placement will be confirmed with the injection of 1-2 mL isotonic saline. Upon confirmation and negative aspiration, 20 mL of 0.25% bupivacaine hydrochloride will be administered on each side under ultrasound guidance.
Postoperative pain intensity (VAS score)
Postoperative pain will be assessed using the visual analog scale (VAS), ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores represent greater pain intensity.
Total opioid consumption via patient-controlled analgesia (PCA)
Requirement for rescue analgesia
Potential Complications
Any complications associated with the block or the surgical procedure (e.g., hematoma, pneumothorax, local anesthetic systemic toxicity, vascular puncture, or infection) will be recorded.
Patient satisfaction
Patient satisfaction will be assessed using Likert scala (1 =very dissatisfied, 2 = dissatisfied, 3 = neutral, 4 = satisfied, 5 = very satisfied). Higher scores indicate greater satisfaction.
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