Ultrasound Guided External Oblique and Rectus Abdominis Plane Block (EXORA) on Neuroendocrine Stress Response in Adults Undergoing Umbilical Hernia Surgery

Umbilical hernias of the abdomen are defined as a non-inguinal, non-hiatal defect in the fascia of the abdominal wall. Surgical stress response refers to the physiologic response to surgery and the hormonal and metabolic changes that follow it.

Fascial plane blocks are gaining attention for perioperative analgesia due to their efficacy and safety profiles. The external oblique and rectus abdominis plane (EXORA) block is an emerging technique that provides a sensory block to the anterolateral abdominal wall, potentially filling gaps left by other commonly used blocks, such as the quadratus lumborum (QLB) or erector spinae plane (ESP) blocks.

• General anesthesia (Other): Patients will receive general anesthesia only.
• External oblique and rectus abdominis plane (EXORA) block (Other): Patients will receive general anesthesia and an external oblique and rectus abdominis plane (EXORA) block with 0.25% bupivacaine.

Primary outcomes

• Neuroendocrine stress response [24 hours postoperatively]: Neuroendocrine stress response will be measured by blood glucose level in adults undergoing umbilical hernia repair.

Secondary outcomes

• Serum cortisol level [24 hours postoperatively]: Serum cortisol level will be measured.
• Time of first rescue analgesia [24 hours postoperatively]: Time of first rescue analgesia will be recorded from the end of surgery till first dose of morphine administration.
• Total intraoperative fentanyl consumption [Intraoperatively]: Rescue dose of intraoperative fentanyl given will be recorded.
• Total morphine consumption [24 hours postoperatively]: Intravenous morphine (rescue analgesic) at a dosage of 3 mg will be administered when the Numerical Rating Scale (NRS) score will be ≥ 4. The total morphine consumption over a 24-hours period will be recorded for these individuals.
• Degree of pain [24 hours postoperatively]: Each patient will be instructed in postoperative pain assessment using the Numerical Rating Scale (NRS), ranging from 0 to 10 (0 = "no pain," 10 = "the worst pain imaginable"). NRS will be assessed at post-anesthesia care unit (PACU),1,2,4,6,12,24 hours postoperative

Sex: All, ages: 21 Years to 65 Years

Inclusion Criteria:

* Aged from 21 to 65 years.
* Both sexes.
* American Society of Anesthesiologists (ASA) Physical status I and Ⅱ.
* Schedule for elective umbilical hernia surgery under general anesthesia.

Exclusion Criteria:

* ASA Ⅲ or Ⅳ.
* Patients with metabolic abnormalities, e.g., diabetes mellitus.
* Patients receiving corticosteroids.
* History of allergies to local anesthetics.
* Bleeding or coagulation disorders.
* Anatomical abnormalities.
* Psychiatric and neurological disorders.
* Complicated hernial defect (obstructed).
* Patient refusal.