Clark J, Son J, Nair GS, Kumar K, Lin C. Rectus sheath block with sedation versus general anesthesia for periumbilical hernia repair: A retrospective propensity score-matched study. World J Anesthesiol 2026; 14(1): 114881 [DOI: 10.5313/wja.v14.i1.114881]
Corresponding Author of This Article
Cheng Lin, MD, Assistant Professor, FRCPC, Department of Anesthesia and Perioperative Medicine, Western University, 1151 Richmond Street, London, Ontario N6A 5C1, Canada. cheng.lin@lhsc.on.ca
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Anesthesiology
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Clark J, Son J, Nair GS, Kumar K, Lin C. Rectus sheath block with sedation versus general anesthesia for periumbilical hernia repair: A retrospective propensity score-matched study. World J Anesthesiol 2026; 14(1): 114881 [DOI: 10.5313/wja.v14.i1.114881]
World J Anesthesiol. Sep 22, 2026; 14(1): 114881 Published online Sep 22, 2026. doi: 10.5313/wja.v14.i1.114881
Rectus sheath block with sedation versus general anesthesia for periumbilical hernia repair: A retrospective propensity score-matched study
Jordyn Clark, Jin Son, Gopakumar Sudhakaran Nair, Kamal Kumar, Cheng Lin
Jordyn Clark, Gopakumar Sudhakaran Nair, Kamal Kumar, Cheng Lin, Department of Anesthesiology and Perioperative Medicine, Western University, London, N6A 5C1, Ontario, Canada
Jin Son, Schulich School of Medicine and Dentistry, Western University, London, N6A 5C1, Ontario, Canada
Author contributions: Clark J was responsible for the inception of study idea, data collection, analysis and manuscript writing and review; Son J was responsible for data collection, manuscript writing and review; Nair GS was responsible for data collection, manuscript writing and review; Kumar K was responsible for the inception of study idea, manuscript writing and review; Lin C was responsible for supervising the project, inception of study idea, data analysis, manuscript writing and review; all of the authors read and approved the final version of the manuscript to be published.
Institutional review board statement: This study was reviewed and approved by the Western University Health Science Research Ethics Board (No. 125656).
Informed consent statement: Consent was obtained or waived by all participants in this study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Data sharing statement: No additional data are available.
Corresponding author: Cheng Lin, MD, Assistant Professor, FRCPC, Department of Anesthesia and Perioperative Medicine, Western University, 1151 Richmond Street, London, Ontario N6A 5C1, Canada. cheng.lin@lhsc.on.ca
Received: October 10, 2025 Revised: November 14, 2025 Accepted: January 27, 2026 Published online: September 22, 2026 Processing time: 355 Days and 22.9 Hours
Abstract
BACKGROUND
Umbilical hernia repair is a surgical procedure commonly performed under general anesthesia (GA). While safe, GA is associated with prolonged post-anesthesia care unit (PACU) recovery due to side effects including drowsiness and postoperative nausea and vomiting. Prolonged PACU stays can contribute to surgical delays, decreased patient satisfaction, and increased operating room costs. Ultrasound-guided rectus sheath block (RSB) with sedation is an alternative that may provide targeted analgesia and minimize opioid use. However, its impact on PACU recovery time compared to GA remains unclear. This study hypothesizes a shorter PACU recovery time for the regional anesthesia group compared to GA.
AIM
To compare PACU recovery time between RSB with sedation and GA for umbilical hernia repair.
METHODS
This single-center retrospective cohort study included adult patients undergoing umbilical hernia repair with either RSB and sedation or GA at Victoria Hospital, London Health Science Centre between January 1, 2017, and July 31, 2024. Multivariable logistic regression was used to model anesthetic modality as a function of age, sex, body mass index, and American Society of Anesthesiologists to generate a propensity score for each patient. The primary outcome was post-anesthetic recovery time. Secondary outcomes included perioperative times, postoperative pain, opioid use, nausea/vomiting, and desaturation events.
RESULTS
After screening 182 patients, 62 patients in each group were propensity matched. RSB with sedation was associated with 17 minutes (95%CI: -25.0 to -9.0) shorter post-anesthetic recovery time compared to GA. Likewise, there was a reduction in operation time by 5 minutes (95%CI: -9.0 to -0.10), and total length of stay by 30 minutes (95%CI: -47.0 to -11.0). While no differences were noted in the incidence of nausea/vomiting, severe pain episodes, and desaturation, the RSB group was correlated with a lower first pain score in PACU and opioid use.
CONCLUSION
RSB with sedation was associated with shorter recovery time, intraoperative time, and hospital length of stay. Future studies should focus on demonstrating a causal relationship between RSB and recovery time.
Core Tip: While rectus sheath block (RSB) is a promising alternative to general anesthesia (GA) for umbilical hernia repair, there is a lack of evidence on its impact on hospital length of stay. This single-center retrospective cohort study included adult patients between 2017 to 2024, and measured the post-anesthetic recovery time between RSB and GA. After screening 182 patients, 62 patients were propensity matched. Compared to GA, RSB with sedation was associated with a reduction in post-anesthetic recovery time, operation time, and total length of hospital stay.
