Surgical rectus sheath block combined with multimodal pain management reduces postoperative pain and analgesic requirement after single-incision laparoscopic appendectomy: a retrospective study

Purpose This study aimed to evaluate the impact of multimodal postoperative pain management, performing a surgical rectus sheath (RS) block via ropivacaine injection into the surgical field after single-incision laparoscopic appendectomy (SILA). Methods Patients who underwent single-incision laparoscopic appendectomy (SILA) for acute appendicitis were divided into three groups and compared: group 1 (multimodal pain management that included intraoperative application of a surgical RS block), group 2 (conventional pain management with intravenous opioids), or group 3 (multimodal pain management without RS block). Forty, 53, and 42 patients were registered, respectively (Table 1). Results Time to start a liquid (1.2 +/- 0.4 h) in group 1 was statistically significantly shorter than that in group 2 (16.3 +/- 8.4 h;p< 0.001) and group 3 (4.93 +/- 2.3 h;p< 0.001). The median and max postoperative VAS scores in group 1 (1.6 +/- 1.2 and 2.2 +/- 1.8, respectively) were statistically significantly lower than that in group 2 (3.0 +/- 1.2 and 4.2 +/- 1.9, respectively;p< 0.001 on both accounts) and group 3 (2.9 +/- 0.6 and 3.4 +/- 1.2, respectively;p< 0.001 on both accounts). The postoperative hospital stay for group 1 (17.0 +/- 9.4 h) was shorter than that for group 2 (44.7 +/- 27.9 h;p< 0.001) and group 3 (35.4 +/- 20.9 h;p< 0.001). RS block was a significant factor for reducing length of hospital stay and postoperative pain in 24 h. Conclusions A surgical RS block combined with multimodal pain management after SILA is a safe and effective method that results in reduced postoperative pain and shorter hospitalization.

Automated summary

Performing a surgical rectus sheath block combined with multimodal pain management after single-incision laparoscopic appendectomy can significantly shorten time to start a liquid, reduce postoperative pain scores, and decrease hospitalization duration.