title: Ultrasound-guided rectus sheath block for single-incision laparoscopic cholecystectomy.
abstract: BACKGROUND
  Single-incision laparoscopic cholecystectomy (SILC) is increasingly applied for cholecystectomy and has been reported as safe and feasible, with short-term operative outcomes equivalent to four-port cholecystectomy. Although many investigators in randomized studies have noted the cosmetic advantages of SILC, the benefit of decreased pain in SILC remains controversial. Therefore, this study aimed to assess the efficacy of the rectus sheath block in SILC with respect to subjective pain.
  
  
  METHODS
  From April 2010 to March 2012, 75 patients with symptomatic gallstone or gallbladder polyps were assigned to one of three groups: (i) four-port laparoscopic cholecystectomy (n = 29); (ii) SILC (n = 15); and (iii) rectus sheath block in SILC (n = 30). We evaluated the operative details, length of hospital stay, and the need and usage of analgesia. Postoperative pain was recorded at 2, 6, 12, and 24 h after surgery based on a visual analog scale.
  
  
  RESULTS
  There was no difference with regard to age, ASA score, BMI, duration of operation, or length of hospital stay among the three groups. A significantly lower pain score was observed in the rectus sheath block in SILC group than in the SILC group at 2 and 6 h after operation. The pain score and need for analgesia were similar between the SILC group and the four-port cholecystectomy group.
  
  
  CONCLUSIONS
  SILC using an ultrasound-guided rectus sheath block significantly reduces postoperative pain.
authors.affiliation: Department of Surgery, Kurume University Medical Center, Kurume, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Kamei
authors.forename: Nobuya
authors.initials: N
authors.lastname: Ishibashi
authors.forename: Gouichi
authors.initials: G
authors.lastname: Nakayama
authors.forename: Nobuya
authors.initials: N
authors.lastname: Hamada
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Ogata
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Akagi
mesh_terms: D000328:Adult; D000368:Aged; D000577:Amides / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000627:therapeutic use*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005260:Female; D005705:Gallbladder Diseases / Q000601:surgery*; D042882:Gallstones / Q000601:surgery; D006801:Humans; D007273:Injections, Intramuscular; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000517:prevention & control*; D011127:Polyps / Q000601:surgery; D017568:Rectus Abdominis; D000077212:Ropivacaine; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine
keywords: Postoperative pain; rectus sheath block; single-incision laparoscopic cholecystectomy