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

Description

Ali Sait Kavakli and co-authors run a randomized trial of a pain block placed under direct camera view during keyhole gallbladder surgery. Standard abdominal wall blocks reach the nerves of the skin and muscle but do little for pain from the peritoneum, the lining inside the abdomen. Their 2026 trial randomly assigned laparoscopic cholecystectomy patients to a deep rectus sheath block, injected into the preperitoneal plane under the surgeon's view, or to no block. Everyone received morphine by patient-controlled pump afterward.

Block patients used a median of 9 milligrams less morphine in the first 24 hours. Their pain scores at rest and on movement were lower at 2, 6, and 12 hours, though the gap closed by 24 hours. Rescue relief and nausea rates matched controls, and quality-of-recovery scores at one day favored the block. The authors argue that aiming at the preperitoneal plane under vision strengthens early pain control.

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Source: https://europepmc.org/article/MED/PMC13457248