Substrate Stiffness and Viscoelasticity Influence Fibroblast Senescence.

Postoperative pain following laparoscopic cholecystectomy is multifactorial, comprising somatic pain from trocar incisions, parietal peritoneal irritation, and visceral pain related to gallbladder bed dissection and diaphragmatic irritation secondary to pneumoperitoneum []. Although overall pain intensity is lower than after open abdominal surgery, inadequate early analgesia may delay mobilization, impair recovery quality, and increase opioid requirements during the immediate postoperative period [, ]. Multimodal analgesia is widely recommended for laparoscopic cholecystectomy and typically includes paracetamol, non-steroidal anti-inflammatory drugs, port-site infiltration, and selective opioid administration []. Regional anesthesia techniques targeting the anterior abdominal wall, such as the transversus abdominis plane (TAP) block and rectus sheath block (RSB), have been investigated to reduce postoperative pain and opioid consumption. However, these techniques predominantly target somatic afferents of the abdominal wall and may have limited influence on the parietal peritoneal component of pain []. Consequently, evidence supporting the routine use of classical RSB in laparoscopic cholecystectomy remains inconsistent, and current procedure-specific recommendations do not uniformly endorse its application [, ]. The parietal peritoneum is highly sensitive to pressure, incision, and inflammatory stimuli due to its somatic innervation, and therefore contributes substantially to early postoperative pain after laparoscopic surgery []. Conventional abdominal wall blocks may provide limited coverage of this component because they primarily target somatic afferents of the anterior abdominal wall []. Accordingly, targeting the preperitoneal plane beneath the posterior rectus sheath has been proposed as a strategy to extend analgesic coverage beyond the abdominal wall. Preperitoneal local anesthetic infiltration was initially described in laparoscopic hernia repair [], and more recently the deep RSB has been introduced as an ultrasound-guided technique targeting this plane []. However, evidence supporting deep RSB or preperitoneal approaches remains limited and is largely based on case reports or small case series [–].