The Impact of Ultrasound-Guided Rectus Sheath Blocks on Intraoperative Anesthetic Requirements and Early Recovery in Laparoscopic Surgery: A Retrospective Cohort Study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background and objective The rectus sheath block (RSB) is increasingly utilized for multimodal analgesia in abdominal surgeries. A properly administered RSB may reduce nociceptive input, thereby lowering the requirement for systemic opioids and intravenous anesthetic agents such as propofol, as well as sedative/analgesic adjuncts such as dexmedetomidine. Moreover, effective regional blockade may attenuate the surgical stress response, contributing to more hemodynamic stability and reducing the use of vasopressors like phenylephrine. This retrospective study aims to evaluate the intraoperative impact of ultrasound-guided RSB in adult patients undergoing laparoscopic abdominal surgery. Methods This retrospective, comparative observational study included 331 adult patients with American Society of Anesthesiologists (ASA) physical status I-III, who underwent elective laparoscopic appendectomy, cholecystectomy, or midline ventral hernia repair (including umbilical and midline incisional hernias). Patients were stratified into an intervention cohort receiving ultrasound-guided RSB (block group, n = 126) and a standard care cohort (no-block group, n = 205). As a non-randomized retrospective study, block allocation was determined by the attending anesthesiologist's discretion, largely influenced by provider preference and operative time constraints. Primary outcomes included the total intraoperative opioid dose (calculated as morphine equivalents), total intravenous anesthetic dose (propofol), and sedative/analgesic adjunct (dexmedetomidine). Secondary outcomes included vasopressor requirement (phenylephrine), time spent in the post-anesthesia care unit (PACU), sedation level at PACU admission, and duration of oxygen supplementation, which may serve as surrogate markers for oversedation related to intraoperative drug administration. Results Baseline demographic and surgical characteristics were well matched. The block group demonstrated a significant reduction in intraoperative opioid consumption compared to the no-block group (median: 5.0 vs. 9.0 morphine milligram equivalents, p < 0.001), with multivariable adjustment confirming a 62.4% reduction in modelled exposure (p < 0.001). However, total intraoperative doses and infusion rates of propofol, dexmedetomidine, and phenylephrine demonstrated no statistically significant differences between the cohorts. Regarding recovery, the RSB was associated with a 72% reduction in the adjusted odds of presenting to the PACU with a modified Aldrete score < 9 (OR: 0.28, p < 0.001). Prolonged oxygen supplementation (>30 min) and overall PACU time did not differ significantly. Conclusions In laparoscopic abdominal surgery, ultrasound-guided RSB serves as a highly effective intraoperative opioid sparing adjunct that significantly enhances immediate functional recovery and PACU discharge readiness. However, the block does not significantly reduce the intraoperative requirements for intravenous anesthetics (propofol), sedative adjuncts (dexmedetomidine), or vasopressors (phenylephrine), indicating its primary intraoperative utility lies in opioid reduction rather than comprehensive anesthetic-sparing or hemodynamic modulation.
Source: Cureus
Institution: Dubai Hospital
Language: English
Subfield: Anesthesiology and Pain Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7214431983