Background: Rectus sheath block (RSB) is a popular technique for post-operative analgesia for patients undergoing abdominal surgeries with midline incisions. Ultrasound-guided erector spinae plane block (ESPB) is an interfacial plane block for the treatment of post-operative neuropathic pain. The aim of this study was to compare the analgesic efficacy of ESPB versus RSB in adult patients undergoing open para-umbilical hernia repair. Methods: This prospective randomized double-blinded study was carried out on seventy-four adult patients with ASA physical status I-II undergoing open paraumbilical hernia repair. Patients were divided into two equal groups: group I (ESPB): patients received bilateral ultrasound-guided ESPB using bupivacaine 0.25% (20 ml) on each side and group II (RSB): patients received bilateral ultrasound-guided RSB using bupivacaine 0.25% (20 ml) on each side. The following measurements was recorded: VAS score, intraoperative fentanyl consumption, the time to the first postoperative rescue analgesia administration, total dose of postoperative rescue analgesia (morphine) consumption, heart rate and mean arterial blood pressure.