Background <p>Acute appendicitis is the leading cause of abdominal surgical emergencies, and appendicectomy is a commonly performed surgery. Although generally regarded as minor, appendicectomies can lead to significant postoperative pain. Rectus sheath blocks (RSB) can provide effective analgesia for 3-port laparoscopic appendicectomy.</p> Methods <p>A total of 145 patients aged between 8 and 18&#xa0;years who underwent laparoscopic appendicectomy were included in this prospective observational study. The study cohort was analyzed in two groups: patients who received RSB (RSB group, <i>n</i> = 68) and control patients who did not receive any type of regional blocks (Control group, <i>n</i> = 77). Data on postoperative pain scores, total analgesic consumption, and the cutaneous sensory coverage of RSB in the port entry areas were collected.</p> Results <p>Postoperative pain scores at the 3rd hour were significantly lower in the RSB group compared to the controls (<i>p</i> &lt; 0.001). Total paracetamol use in the first 24&#xa0;h was also reduced in the RSB group (<i>p</i> &lt; 0.001). The need for rescue analgesics was slightly lower in the RSB group (<i>p</i> = 0.047). Total procedural time showed no significant difference between the groups. In the postoperative 3rd hour assessment of the RSB blocks: all patients experienced visceral pain to varying degrees, three (4.4%) had pain at the umbilical port entry site, fourteen (20.6%) had pain at the left iliac fossa port entry site, and eight (11.8%) had pain at the suprapubic port entry site.</p> Conclusions <p>RSB can improve pain scores and reduce overall analgesic consumption in pediatric laparoscopic appendicectomies. However, RSB may miss the lateral trocar entry site, and suprapubic coverage can differ among individuals.</p> Trial registration <p>NCT06913205.</p>