Hamadan University of Medical Sciences Avicenna journal of Care and Health in Operating Room 2981-0639 3 3 2025 10 28 Evaluation of the Effectiveness of Ultrasound-Guided Rectus Sheath Blocks in Patients Undergoing Midline Abdominal Surgery 87 91 10.34172/ajchor.115 EN Farzaneh Kenshlou https://orcid.org/0000-0002-3374-8045 Mahshid Nikooseresht Mohammad Ali Seif Rabiei Afshin Farhanchi https://orcid.org/0000-0003-4028-0556 Journal Article 10.34172/ajchor.115 2025 08 12 2025 09 24 Introduction: Postoperative pain after major abdominal surgery, particularly procedures performed through midline incisions, remains a serious clinical challenge. Despite their effectiveness, conventional analgesic techniques, including patient-controlled analgesia (PCA) and epidural analgesia have notable limitations and complications. The ultrasound-guided rectus sheath block has emerged as a regional analgesic technique that may provide effective anterior abdominal wall analgesia with fewer adverse effects. Thus, this study aimed to evaluate the effectiveness of ultrasound-guided rectus sheath catheter analgesia in reducing postoperative pain following midline abdominal surgery. Secondary outcomes included opioid consumption, early ambulation, return of bowel function, sleep quality, patient satisfaction, and length of hospital stay. Methods: In this randomized controlled study, 60 patients undergoing elective midline abdominal surgery (ASA II–III) were allocated to block and control groups. All patients received standardized general anesthesia and postoperative PCA. The intervention group also received bilateral ultrasound-guided rectus sheath block with 0.125% bupivacaine. Pain intensity (visual analog scale), PCA usage, opioid consumption, nausea and vomiting, bowel sounds, mobility, sleep quality, and supplemental analgesic requirements were assessed over the first 24 postoperative hours. Ultimately, data were analyzed using appropriate non-parametric statistical tests. Results: Patients receiving rectus sheath block experienced significantly lower pain scores at all measured time points, reduced PCA activation and opioid consumption, earlier ambulation, earlier return of bowel sounds, improved sleep quality, and reduced need for antiemetics and supplemental morphine compared with the control group. Conclusion: Overall, ultrasound-guided rectus sheath block provides effective postoperative analgesia after midline abdominal surgery, considerably reduces opioid requirements, and enhances multiple recovery parameters. Despite methodological limitations, these findings support the incorporation of rectus sheath block into multimodal analgesic strategies, with further large-scale studies warranted.