Serpil Şehirlioğlu
Anatolian Current Medical Journal - 2025;7(6):840-846
Aims: Anterior quadratus lumborum block (QLB) is a fascial plane block that provides effective analgesia in the lower abdomen. Dexamethasone is known to enhance analgesic efficacy when used as an adjuvant to local anesthetics. However, its role as an adjuvant in fascial plane blocks remains uncertain. This study aimed to evaluate the effect of adding dexamethasone to anterior QLB in patients undergoing unilateral open inguinal hernia repair (OIHR) under spinal anesthesia. Methods: In this prospective, randomized, double-blinded study, 67 patients scheduled for unilateral OIHR were randomly assigned into two groups. Both groups received ultrasound-guided anterior QLB: the QLB group (n=34) received bupivacaine alone, whereas the A-QLB group (n=33) received bupivacaine combined with dexamethasone. All surgeries were performed with a standardized mesh technique. The primary outcome was the time to first rescue analgesia within 24 hours. Secondary outcomes included total analgesic consumption, resting and dynamic numeric rating scale (NRS) scores, and postoperative complications. Results: The addition of dexamethasone did not significantly prolong the time to first rescue analgesia or reduce total analgesic consumption compared with bupivacaine alone. However, the A-QLB group showed significantly lower dynamic NRS scores at 8, 12, and 24 hours and lower resting NRS scores at 12 hours (p<0.05). Approximately 30% of patients in both groups required rescue analgesia. No quadriceps weakness was observed, and the incidence of postoperative nausea and vomiting was similar between groups. Conclusion: The addition of dexamethasone to anterior QLB improved postoperative pain scores, particularly during movement, but did not prolong analgesia duration or reduce total analgesic consumption. These findings suggest that dexamethasone enhances analgesic quality and patient comfort without increasing adverse effects.
