Comparison Between Ultra Sound Guided Rectus Sheath Block and Field Block for Midline Hernia Repair
Condition: Ultrasound Guided Rectus Sheath Block; Pain, Postoperative
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      Randomized double blinded controlled clinical trial will be done with a total number of 75
      patients will be divided into 3 groups. To compare between Ultra-sound guided rectus sheath
      block VS Field block infiltration in providing a good analgesia for patients undergoing
      midline hernia repair to detect which one is superior.
    

Detailed description: 
      75 patients undergoing midline hernia repair under general anesthesia will be recruited and
      will be randomly allocated using closed envelope technique as follows: Control group, Local
      infilteration (Field block infilteration) group, Ultra sound Guided Rectus sheath block
      group.

      General anesthesia will be standardized for all patients with :

      2 µg kg-1 fentanyl and 2 mg kg-1 propofol. Neuromuscular blockade will be achieved with 0.5
      mg kg-1 atracurium followed by tracheal intubation.

      Muscle relaxation will be maintained by 0.1mg / kg / 30 minute of Atracrurium. Anesthesia
      will be maintained by sevoflurane. Mechanical ventilation will be adjusted with fresh gas
      flow oxygen in air 30-50% at a rate of 1 L min-1to maintain end-tidal carbon dioxide of 35-40
      mm Hg and Spo2 greater than 94%.

      BIS values will be maintained between 40 and 60. All surgical procedures will be done in the
      range between 10 am and 1 pm and by the same surgical team.

        1. Control group : will receive field block using 0.3 ml/kg of normal saline at site of the
           hernia plus ultra- sound guided rectus sheath injection using 0.3 ml / kg of normal
           saline.

        2. Field block group: will receive 0.3 ml / kg of 0.5% bupivicaine subcutaneously
           surrounding the site of the hernia following the induction of anesthesia and ultra-sound
           guided rectus sheath block with 0.3 ml / kg of normal saline.

        3. Ultrasound guided rectus sheath block : Under sterile conditions a 21/22 G , 50- 100
           milli meter length echogenic needle guided by the ultrasound into rectus sheath at the
           level of the umbilicus , using an - in plane technique. After -ve aspiration 0.3 ml/ kg
           of 0.5 % bupivicaine will be deposited on each side and the spread of local anesthesia
           will be observed by ultrasound plus 0.3 ml/kg of normal saline subcutaneously at the
           site of the hernia.

      All solutions used will be prepared by a colleague who will not participate into the study.
    

Intervention name(s): Bupivacaine Hydrochloride 0.5% Injection Solution_#4; Normal Saline Flush, 0.9% Injectable Solution_#5; Bupivacaine Hydrochloride 0.5% Injection Solution_#4
Intervention type(s): Drug; Drug; Drug
Intervention description(s): ultra sound guided injection into the rectus sheath; injected into rectus sheath using ultrasound & locally surrounding the hernia; locally surrounding the hernia
Intervention MeSH terms: Bupivacaine; Pharmaceutical Solutions
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Supportive Care