Comparative Study Between Ultrasound Guided Quadratus Lumborum Versus Ilioingunial/ Iliohypogastric Nerves Block as Post-operative Analgesia for Patients Undergoing Inguinal Hernia Repair Surgeries

In the anesthesia clinic, an informed written consent will be taken from every patient one day before the surgery. Explanation of the visual analogue score (VAS) will be performed. History, clinical examination and routine investigations including; complete blood count (CBC), fasting blood sugar (FBS), liver function test (LFT), kidney function test (KFT), electrocardiogram (ECG), prothrombin time (PT) and activated partial thromboplastin time (aPTT) will be performed to all patients.

In the induction room, an intravenous (IV) 20 gauge cannula will be inserted and premedication will be limited to intravenous (IV) midazolam (0.03 mg/kg).

• Intra-operative setting:
• General anesthesia technique:

The patient will be fasting for at least 8 hours preoperatively. A standardized general anesthesia protocol will be used for all patients. General anesthesia will be induced with propofol (1.5-2 mg /kg) and fentanyl (1 µg /kg) with neuromuscular block Atracurium (0.5mg/kg at induction then 0.1mg/kg as maintenance dose. The patient's airway will be maintained using an endotracheal tube. Maintenance of anesthesia will be commenced using isoflurane (1.2%) in a 50% mixture of oxygen in air.

Ventilator Settings: the ventilation will be achieved with a volume-controlled mode ventilation, respiratory rate adjusted according to EtCO2 to range between 30-35 mmHg, a tidal volume of 6-8 ml/kg and mixture of gases in proportion 50% oxygen and 50% air, with PEEP 5 cm H2O using a closed circle system with a total fresh gas flow rate of 3L/min.