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

The Effect of Ultrasound Guided External Oblique and Rectus Abdominis Plane Block (EXORA) on Neuroendocrine Stress Response in Adults Undergoing Umbilical Hernia Surgery: A Prospective Randomized Controlled Trial

This study aims to evaluate the efficacy of ultrasound-guided external oblique and rectus abdominis plane block on the neuroendocrine stress response and postoperative analgesia in adults undergoing umbilical hernia repair.

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.

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.