Rectus sheath block provides superior analgesia over quadratus lumborum block in single-port total laparoscopic hysterectomy: a prospective, randomized trial

With the growing adoption of minimally invasive surgery, single-port total laparoscopic hysterectomy (TLH) is gaining popularity. However, unlike multi-port TLH, evidence on optimal pain management strategies for single-port TLH remains limited. Given the key role of regional anesthesia in multimodal analgesia, identifying the more effective block technique is clinically relevant. This study aimed to compare the analgesic efficacy of the quadratus lumborum block (QLB) and rectus sheath block (RSB) in patients undergoing single-port TLH. We hypothesized that QLB would result in lower 24-hour cumulative opioid consumption than RSB. In this prospective, randomized trial, 62 patients undergoing single-port TLH were assigned to receive either RSB or QLB. The primary outcome was 24-hour cumulative opioid consumption. Secondary outcomes included time to first patient-controlled analgesia (PCA) bolus, pain scores, and the need for rescue analgesia. Data from 52 patients were analyzed (RSB: 27; QLB: 25). Median 24-hour opioid consumption was significantly lower in the RSB group (277.9 versus 459.1 μg; P = 0.007). Although the median time to first PCA bolus was similar between groups, Kaplan-Meier survival analysis revealed a marginal but statistically significant difference favoring RSB (P = 0.047). Notably, no patients in the RSB group required rescue analgesia, compared to 20% in the QLB group (P = 0.020). RSB provided superior postoperative analgesia compared to QLB in single-port TLH, reducing both opioid consumption and the need for rescue analgesia. These findings support RSB as the preferred block within a multimodal analgesia strategy for this procedure.