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. 2025 Apr 1;35(2):e1358.
doi: 10.1097/SLE.0000000000001358.

Rectus Sheath and Transversus Abdominis Plane Blocks for Preaponeurotic Endoscopic Repair: Is the Double Block the Solution for Postoperative Pain Management?

Antonio Toscano  1 , Luca Domenico Bonomo  2 , Paolo Capuano  3 , Luca Cremascoli  1 , Filippo Castelli  1 , Mattia Puppo  1 , Fabrizio Aprà  4 , Alberto Jannaci  4 , Salvatore Cuccomarino  5
Affiliations

Rectus Sheath and Transversus Abdominis Plane Blocks for Preaponeurotic Endoscopic Repair: Is the Double Block the Solution for Postoperative Pain Management?

Antonio Toscano et al. Surg Laparosc Endosc Percutan Tech. .

Abstract

Background: Diastasis recti abdominis (DRA) is a prevalent postpartum condition characterized by the separation of the rectus abdominis muscles with an interrectal distance >2.5 cm, often leading to symptoms like back pain, constipation, and urinary incontinence. Preaponeurotic endoscopic repair (REPA) is a novel, minimally invasive surgical approach for DRA, offering an alternative to traditional abdominoplasty. Despite its minimally invasive nature, REPA surgery poses significant postoperative pain challenges, typically managed with opioids, which carry numerous side effects.

Materials and methods: This retrospective study evaluates the efficacy of combining 2 ultrasound-guided abdominal wall blocks, rectus sheath block (RSB) and transversus abdominis plane block (TAPB), to manage postoperative pain in 55 DRA patients who underwent REPA surgery. We performed lateral TAPB in 28 cases, whereas 27 received an association of TAPB and RSB.

Results: At 6 hours postsurgery, 61% of patients in the TAPB group reported significant pain (Numeric Rating Scale >3), compared with 19% in the TAPB-RSB group ( P = 0.001). The TAPB-RSB group also required fewer analgesic rescue doses ( P = 0.042) and showed earlier recovery, with faster initiation of oral intake and mobility.

Conclusion: The combination of TAPB and RSB significantly reduces opioid consumption, postoperative pain, and the need for rescue analgesia compared with TAPB alone. The dual-block approach, providing a multi-dermatomal sensory block, suggests a promising strategy for improving postoperative pain management in REPA surgery.

Keywords: diastasis recti; pain management; preaponeurotic endoscopic repair; rectus sheath block; transversus abdominis plane block.

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Conflict of interest statement

The authors declare no conflicts of interest.

References

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