Efficacy of Rectus Sheath Block in the Management of Laparoscopic Cholecystectomy Mediated Pain: A Narrative Review.

PURPOSE OF REVIEW: Effective postoperative pain management is essential for optimizing recovery after laparoscopic cholecystectomy, one of the most commonly performed abdominal surgeries. Despite being minimally invasive, the procedure is associated with significant somatic pain, which is frequently managed with systemic opioids and non-opioid analgesics. However, the reliance on opioids raises concerns related to associated side effects such as nausea, sedation, respiratory depression, and risk of dependence. RECENT FINDINGS: Regional anesthesia techniques, including the rectus sheath block, have gained attention as promising adjuncts or alternatives for pain control. The rectus sheath block specifically targets the anterior abdominal wall by anesthetizing the terminal branches of the intercostal nerves, potentially reducing incisional pain. This narrative review explores the anatomical rationale, technique, and current evidence on the efficacy of rectus sheath block for pain management following a laparoscopic cholecystectomy. We summarize findings from randomized controlled trials and observational studies comparing the rectus sheath block with placebo, systemic analgesia, and other regional techniques such as the transversus abdominis plane block. Outcomes of interest include postoperative pain scores, opioid consumption, time to ambulation, and incidence of adverse effects. While results vary across studies, the current literature suggests that the rectus sheath block may contribute to improved postoperative analgesia and reduced opioid requirements, particularly when combined with multimodal analgesic regimens. However, variations in study quality and differences in how the block is performed make it hard to draw firm conclusions. Well-designed, consistent research is needed to better understand the role of the rectus sheath block in recovery following a laparoscopic cholecystectomy.