The general anaesthesia will be induced with injection fentanyl (1.5 -2μg/kg) and propofol (1.5 - 2.0 mg/kg). The endotracheal intubation will be facilitated by using muscle relaxant atracurium besylate (0.5mg/kg) after confirming adequacy of ventilation and loss of consciousness. The airway will be secured with appropriate size of endotracheal tube. The anaesthesia will be maintained with air oxygen (50:50), isoflurane and atracurium besylate. Supplemental analgesia will be providing with injection fentanyl (1 μg/kg) when rise in HR or MAP more than 20% of base line values. Continuous monitoring of HR, NIBP, SpO₂ and end tidal carbon-dioxide (EtCO₂) will be done throughout intra operative period and recorded every 15 min. The EtCO₂ will be maintained between 35-40 mm Hg. The number of doses and total amount of supplement analgesia intra operative with fentanyl will be recorded for comparison between two groups. Fifteen min before surgery completion ondansetron 8 mg i.v. given. After completion of surgery bilateral rectus sheath block will be given according to allocated group. 

Rectus sheath block will be given  under all aseptic precaution as per study group, with real-time ultra-sonographic guidance (13-6 MHz Linear Array Transducer; Sonosite M-Turboâ„¢, Bothell, WA, USA) using a 22G (0.70 mm × 50 mm) via an in-plane approach to the rectus sheath.The probe will be placed horizontally over the rectus sheath at T10 level on either side of the midline.The posterior rectus muscle sheath and the fascia transversalis will be identified as twin hyperechoic lines. A Stimuplex®A insulated needle (B. Braun, Melsungen, Germany) connected to an infusion line was introduced in plane with the US probe in a medial to lateral direction at an angle of approximately 45° to the skin plane. Under real-time US guidance, the needle will be gradually advanced posterior to the rectus muscle and above the underlying rectus sheath toward its lateral edge, approaching the rectus sheath with the blunt side of the bevel, lateral to the deep inferior epigastric artery to avoid damaging it with the needle. Following negative aspiration testing, a bolus of 1 mL of 21 mL drug solution will be slowly injected through the needle. If intramuscular spread of the LA occurred, the needle will be advanced until the rectus muscle will be separated from the posterior rectus sheath by hydrodissection.  At this point, the remaining anesthetic solution will be deposited under US guidance. The same procedure will be repeated on the opposite side.

After performing the block, residual neuromuscular blockade will be reversed with neostigmine 0.05 mg/kg and glycopyrrolate 0.01 mg/kg i.v. and the trachea will be extubated when the patient is fully awake and breathing adequately. The patients will be shifted to the post anaesthesia recovery unit (PACU) for further management. The total duration of the surgery will be also recorded. Post operatively patients will be given morphine 3 mg i.v. as rescue analgesia, if NRS ≥4.  HR, NIBP, SpO₂, RR and NRS score will be recorded at 0, 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 22 and 24 h after the surgery. Time to first rescue analgesia as well as the total doses of morphine used in first 24 h will be recorded. Any side effects like nausea, vomiting, respiratory depression, hypotension, sign and symptoms of local anaesthetic toxicity will be recorded and treated accordingly. Nausea lasting more than 10 min or vomiting will be treated with ondansetron 4mg i.v.The patient’s satisfaction score will be noted.

The following characteristics of the block will be observed postoperatively: 1.      Duration of analgesia: Duration of analgesia will be defined as the time interval from completion of local anesthetic administration till first need of rescue analgesic. The rescue analgesic regime morphine3 mgi.v. slowly as analgesic whenever NRS ≥ 4 or on request. 

2. Pain assessment: The numerical rating scale (NRS) is a segmented numeric version of the visual analog scale (VAS) in which a respondent selects a whole number (0–10 integers) that best reflects the intensity of his/her pain. The common format is a horizontal bar or line which contains 11-point numeric scale ranges from ’0’ representing one pain extreme (e.g. “no pain”) to ’10’ representing the other pain extreme (e.g. “pain as bad as you can imagine”or “worst pain imaginable”). NRS for pain will be assessed during rest (NRS-R) and movement (NRS-M) at predefined intervals at 0, 2, 4, 6, 8, 10, 12, 15, 18, 21 and 24 h postoperatively.

3. Total rescue analgesic consumption: The total dose of morphine used in initial 24 h.

4. Postoperative side effects or complications: Local anesthetic toxicity, nausea, vomiting, pruritus, drowsiness, convulsions etc.

5. Hemodynamic and respiratory changes: Bradycardia (pulse <50 beats/min), hypotension (reduction of MAP >20% of baseline), respiratory depression (RR ≤8 breaths/minute or SpO2< 90%).

6. Patient’s satisfaction score:    4 = excellent, 3 = good, 2 = fair, 1 = poor.