Ultrasound-Guided Ilioinguinal-Iliohypogastric Nerve Block Following Spinal Anesthesia Comparing Dexmedetomidine Versus Nalbuphine as Adjuvants to Bupivacaine in Unilateral Inguinal Hernia Repair

This study evaluates and compares the pain-relieving efficacy and safety of adding either dexmedetomidine or nalbuphine to bupivacaine in an ultrasound-guided ilioinguinal-iliohypogastric nerve block for patients undergoing elective unilateral inguinal hernia repair under spinal anesthesia.

While spinal anesthesia provides effective surgical anesthesia, postoperative pain often increases as the block recedes. Supplementing spinal anesthesia with an ultrasound-guided peripheral nerve block targeting the ilioinguinal and iliohypogastric nerves provides localized pain relief. Adding adjuvant medications to the local anesthetic may extend the duration of pain control and reduce systemic analgesic requirements.

Participants are randomly allocated to one of three groups:

* Control Group: Receives bupivacaine with normal saline. * Nalbuphine Group: Receives bupivacaine combined with nalbuphine. * Dexmedetomidine Group: Receives bupivacaine combined with dexmedetomidine.

The primary objective is to assess the duration of analgesia by measuring the time from the regression of spinal sensory anesthesia until the first request for rescue pain medication. Secondary objectives include evaluating total 24-hour pain medication consumption, postoperative pain scores, vital signs, sedation scores, patient satisfaction, and side effects.

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Key information

Conditions

Inguinal Hernia Hernia Hernia, Abdominal Hernia, Inguinal Neurologic Manifestations Pain Pain, Postoperative Pathologic Processes Pathological Conditions, Anatomical Pathological Conditions, Signs and Symptoms Postoperative Complications Postoperative Pain Signs and Symptoms

Age range

18 year–65 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Phase 4

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

Age 18 to 65 years
American Society of Anesthesiologists (ASA) physical status I or II
Scheduled for elective unilateral primary inguinal hernia repair under spinal anesthesia supplemented with ilioinguinal-iliohypogastric nerve block
Body weight between 45 and 100 kg and body mass index (BMI) <= 35 kg/m^2
Ability to understand the study protocol, comply with study requirements, and communicate pain intensity using the Visual Analog Scale (VAS)

Exclusion criteria

Known allergy or hypersensitivity to amide-type local anesthetics, dexmedetomidine, or nalbuphine
Contraindications to spinal anesthesia (e.g., severe hypovolemia, elevated intracranial pressure, active infection at the lumbar puncture site, severe spinal deformity)
History of neurological disorders (e.g., peripheral neuropathy, myopathy, seizure disorders, or cognitive impairment)
Coagulopathy, concurrent anticoagulant therapy, or local infection at the block site contraindicating regional anesthesia
Severe hepatic, renal, or cardiovascular disease (e.g., heart block, uncontrolled hypertension, ischemic heart disease, severe valvular disease, chronic renal failure, or liver cirrhosis)
History of opioid or substance abuse
Emergency surgical procedures
Procedures expected to exceed 3 hours or requiring conversion to general anesthesia

Treatment and study plan

Bupivacaine

Drug

Single-injection ultrasound-guided ilioinguinal-iliohypogastric (IIIH) nerve block administered immediately after spinal anesthesia. The injectate consists of 8 mL 0.5% bupivacaine (40 mg) combined with 2 mL sterile 0.9% normal saline to achieve a total volume of 10 mL (final bupivacaine concentration 0.4%).

Nalbuphine

Drug

Single-injection ultrasound-guided ilioinguinal-iliohypogastric (IIIH) nerve block administered immediately after spinal anesthesia. The injectate consists of 8 mL 0.5% bupivacaine (40 mg) combined with nalbuphine 10 mg, diluted with sterile 0.9% normal saline to achieve a total volume of 10 mL (final bupivacaine concentration 0.4%).

Dexmedetomidine

Drug

Single-injection ultrasound-guided ilioinguinal-iliohypogastric (IIIH) nerve block administered immediately after spinal anesthesia. The injectate consists of 8 mL 0.5% bupivacaine (40 mg) combined with dexmedetomidine 1 µg/kg, diluted with sterile 0.9% normal saline to achieve a total volume of 10 mL (final bupivacaine concentration 0.4%).

Primary outcomes

Time to First Rescue Analgesia

Time frame: Up to 24 hours postoperatively

Time in minutes from the documented regression of spinal sensory block to the T12 dermatome until the patient's first request for rescue analgesia, administered when the Visual Analog Scale (VAS) pain score is 4 or greater (scale of 0 = no pain to 10 = worst imaginable pain).

Sponsors and collaborators

Lead sponsor

Assiut University

Other

Registry information

Official study title

Ultrasound-Guided Ilioinguinal-Iliohypogastric Nerve Block Following Spinal Anesthesia Comparing Dexmedetomidine Versus Nalbuphine as Adjuvants to Bupivacaine in Unilateral Inguinal Hernia Repair: A Prospective, Randomized, Double-Blind Controlled Study

Important dates

Study start: 2026
Primary completion: 2027
Study completion: 2027
First posted: Sep 23, 2026
Registry last updated: Sep 23, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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