Rectus sheath block for postoperative analgesia in abdominal surgery: A systematic review and meta-analysis of randomized controlled trials

The rectus sheath block is a potentially effective regional anesthetic technique for postoperative analgesia. However, evidence regarding its effectiveness across different surgical approaches and comparator techniques has remained inconsistent. We conducted a meta-analysis to evaluate the postoperative analgesic effectiveness of the rectus sheath block in abdominal surgery. Our study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. In October 2025, we searched four databases (PUBMED, OVID Medline, SCOPUS, and Web of Science) for randomized controlled trials assessing the analgesic efficacy of the rectus sheath block following abdominal surgery. The primary outcomes were pain scores at rest measured at 0-2, 10-12, and 12-24 hours postoperatively. The secondary outcome was postoperative 24-hour intravenous morphine-equivalent consumption. Thirty-one randomized controlled trials involving 1076 participants who received the rectus sheath block and 1,065 who received alternative analgesic care were included. The rectus sheath block significantly reduced postoperative pain at 0-2 hours (mean difference [MD], -1.46, 95% CI, [ -2.26 to -0.66]; P < 0.001), 10-12 hours (MD, -0.94, 95% CI, [ -1.40 to -0.48]; P < 0.001), and 12-24 hours (MD, -0.65, 95% CI, [ -1.07 to -0.23]; P = 0.002). Twenty four-hour intravenous morphine-equivalent consumption was significantly lower with the rectus sheath block (MD, -7.40, 95% CI, [ -11.86 to -2.94]; P = 0.001). Rectus sheath block was associated with reduced postoperative pain scores and reduced opioid use in the first 24 hours after abdominal surgery. Clinical trial registration: CRD420251208643 (PROSPERO).