Preperitoneal analgesia under direct visualization: laparoscopic-guided deep rectus sheath block improves…

Randomized trialSurgical endoscopy· Aug 2026

Preperitoneal analgesia under direct visualization: laparoscopic-guided deep rectus sheath block improves postoperative pain control after laparoscopic cholecystectomy: a randomized controlled trial.

Ali Sait Kavakli, Mehmet Abdussamet Bozkurt, Musa Diri … Ares Cekem

Regional AnesthesiaRandomized trialTreatmentQ1IF 3.2

Laparoscopic deep rectus sheath block cut 24-hour morphine use after cholecystectomy

Preperitoneal analgesia under direct visualization: laparoscopic-guided deep rectus sheath block improves postoperative pain control after laparoscopic cholecystectomy: a randomized controlled trial.

Ali Sait Kavakli … Ares Cekem

Surgical endoscopy · Aug 2026

Background

Conventional abdominal wall blocks primarily target somatic afferent nerves and may therefore provide limited relief for the peritoneal component of postoperative pain.

Purpose

This study aimed to investigate whether a laparoscopic-guided deep rectus sheath (preperitoneal) block (RSB) could reduce postoperative opioid consumption and improve postoperative pain in patients undergoing laparoscopic cholecystectomy.

Methods

Were randomly assigned to either the control group or the deep RSB group.

Results

less morphine needed in the first 24 hours after surgery

MD -9 (95% CI -11 to -6)

null 0

-11

-6

CI excludes the null - significant

More results

Pain scores at rest and during movement were significantly lower in the deep RSB group at 2, 6, and 12 h postoperatively, with no significant difference observed at 24 h.

Rescue analgesia requirement and incidence of postoperative nausea and vomiting were similar between groups.

More results

Quality-of-recovery scores at 24 h were significantly higher in the deep RSB group.

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Conclusion · 1 of 2

Laparoscopic-guided deep RSB significantly reduced postoperative opioid consumption and improved early postoperative pain control after laparoscopic cholecystectomy.

Conclusion · 2 of 2

Targeting the preperitoneal plane under direct laparoscopic visualization may enhance early multimodal analgesia in these patients. TRIAL REGISTRY: ClinicalTrials.gov identifier: NCT06976320.

Preperitoneal analgesia under direct visualization: laparoscopic-guided deep rectus sheath block improves postoperative pain control after laparoscopic cholecystectomy: a randomized controlled trial.

Preperitoneal analgesia under direct visualization: laparoscopic-guided deep rectus sheath block improves postoperative pain control after laparoscopic cholecystectomy: a randomized controlled trial.

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