Abstract Background Gallstone disease with its consequences is a common clinical issue that may necessitate surgical removal. In comparison with traditional open procedures, laparoscopic cholecystectomy (LC) remains the mainstay treatment for symptomatic gallstone disease and can lead to a shorter recovery period, and a shorter hospital stay; yet, severe abdominal and shoulder pain may be experienced. Main body Novel drugs and technology for acute and chronic pain management following LC have been studied to improve patient care. The review discusses innovative pain management strategies with non-opioid approaches for laparoscopic surgery, with an emphasis on ensuring speedy and safe recovery. Conclusion The key findings state that IV paracetamol is a necessary part of multimodal postoperative pain management. There were several pharmacological interventions found to be effective in pain control: magnesium sulfate and dexamethasone showed anti-inflammatory benefits; ondansetron provided analgesic effects; gabapentinoids and alpha-2-agonists reduced central sensitization; local anesthetics offered targeted pain relief; antidepressants addressed neuropathic pain; NSAIDs proved effective for inflammatory pain. Similarly, non-pharmacological approaches, and emerging technologies, also contributed to the management of post-LC pain underscoring the need for a comprehensive approach to its management. More rigorous research is needed to guide pain management after LC. Future studies should compare multiple treatments simultaneously and involve larger patient groups. This approach will help identify optimal pain control strategies. It will also provide clearer insights into the safety and efficacy of various pain medications under comparable clinical conditions. 

Postoperative pain management following laparoscopic cholecystectomy-non-opioid approaches: a review

Abstract Introduction This meta-analysis aimed to compare the analgesic efficacy of intraperitoneal ropivacaine versus bupivacaine for laparoscopic cholecystectomy. Methods We searched PubMed, EMbase, Web of Science, EBSCO, and Cochrane Library databases from inception through January 2020 and included randomized controlled trials (RCTs) evaluating the analgesic efficacy of ropivacaine versus bupivacaine for laparoscopic cholecystectomy. Results Five RCTs are included in the meta-analysis. In patients with laparoscopic cholecystectomy, ropivacaine and bupivacaine demonstrated comparable pain scores at 2 h (SMD = –0.22; 95% CI = –0.54 to 0.10; p = 0.18), 4 h (SMD = –0.16; 95% CI = –0.42 to 0.10; p = 0.22), 8 h (SMD = –0.60; 95% CI = –1.19 to –0.01; p = 0.05), and 24 h (SMD = 0.33; 95% CI = –1.19 to 1.84; p = 0.67), as well as time to first analgesic requirement (SMD = 0.10; 95% CI = –0.23 to 0.42; p = 0.56). Conclusions Intraperitoneal ropivacaine and bupivacaine have a similar analgesic efficacy for laparoscopic cholecystectomy. 

The Analgesic Efficacy of Intraperitoneal Ropivacaine Versus Bupivacaine for Laparoscopic Cholecystectomy: a Meta-Analysis

Introduction l´effet des corticoïdes administrés en intraveineux sur la douleur post opératoire a été bien démontré cependant peu de travaux se sont intéressés à l´intérêt de leur utilisation en intrapéritonéal après chirurgie laparoscopique. Le but de notre travail était d´évaluer l´effet de l´instillation intra péritonéale de dexaméthasone sur l´analgésie post opératoire après cholécystectomie laparoscopique. Méthodes nous avons mené une étude prospective randomisée contrôlée en double aveugle, incluant des patients proposés pour cholécystectomie laparoscopique programmée et randomisés en deux groupes: groupe D (ayant reçus 16 ml: 12 ml de sérum physiologique et 4 ml de solution contenant 16 mg de dexaméthasone) et groupe T (ayant reçus 16 ml de sérum physiologique). Le critère de jugement principal était: l´échelle visuelle analogique (EVA) de la douleur abdominale durant les 24 premières heures postopératoires. Les critères de jugement secondaires étaient l´incidence de la douleur de l´épaule, le délai de la première demande analgésique, la consommation de morphiniques en salle de surveillance post interventionnelle (SSPI), la consommation d´analgésiques non morphiniques et l´incidence des nausées et des vomissements durant les premières 24 heures postopératoires et la présence de complications. Résultats soixante patients ont été inclus et répartis en deux groupes de 30. Les paramètres démographiques, la durée de l´acte opératoire et de l´anesthésie ainsi que la consommation de fentanyl en per opératoire ont été comparables entre les deux groupes. Les valeurs de l´EVA de la douleur abdominale (p≤0,001), l´incidence des douleurs au niveau de l´épaule (p<0,001), la consommation d´opioïdes et d´analgésiques (p<0,001) et l´incidence des nausées (p=0,002) et des vomissements (p=0,012) durant les premières 24 heures postopératoires ont été significativement plus basses pour le groupe D. Aucune complication liée à l´administration de dexaméthasone n´a été notée. Conclusion la dexaméthasone en intra péritonéale a diminué les douleurs postopératoires après une cholécystectomie laparoscopique.

Intérêt de la déxaméthasone en intrapéritonéale dans l’analgésie post cholécystectomie laparoscopique: étude prospective contrôlée randomisée en double aveugle

Introduction
the effect of intravenous corticosteroids on postoperative pain has been well demonstrated; however, few studies have focused on the efficacy of intraperitoneal corticosteroid use after laparoscopic surgery. The purpose of this study was to evaluate the effect of intraperitoneal administration of dexamethasone on postoperative analgesia after laparoscopic cholecystectomy.


Methods
we conducted a prospective, randomised, double-blind, controlled study, including patients scheduled for laparoscopic cholecystectomy and randomised into two groups: the group D (receiving 16 ml: 12 ml saline and 4 ml solution containing 16mg dexamethasone) and the group T (receiving 16 ml saline). The primary endpoint was: Visual Analogue Scale (VAS) for abdominal pain during the first 24 hours after surgery. The secondary endpoints were the incidence of shoulder pain, time to first request for analgesia, the consumption of morphine in the post-intervention surveillance room (PACU), the consumption of non-opioid analgesics and the incidence of nausea and vomiting during the first 24 hours after surgery as well as the presence of complications.


Results
sixty patients were included in the study and divided into two groups of 30. Demographic parameters, duration of surgical and anesthesia procedures, as well as intraoperative fentanyl consumption were comparable between the two groups. Abdominal pain VAS values (p≤0.001), the incidence of shoulder pain (p<0.001), opioid and analgesic consumption (p<0.001) and the incidence of nausea (p=0.002) and vomiting (p=0.012) during the first 24 hours after surgery were significantly lower in group D. No complications related to dexamethasone administration were noted.


Conclusion
intraperitoneal dexamethasone reduces postoperative pain after laparoscopic cholecystectomy.

[The effect of intraperitoneal administration of dexamethasone on postoperative analgesia after laparoscopic cholecystectomy: a prospective randomized controlled double-blind study].

https://www.tandfonline.com/doi/pdf/10.1080/11101849.2022.2127524?needAccess=true

Surgicel® fibrillar as an innovative analgesic reservoir for post-laparoscopic cholecystectomy pain management: Randomized double-blind trial

INTRODUCTION The influence of intraperitoneal levobupivacaine on pain relief after laparoscopic cholecystectomy remains controversial. We conducted a systematic review and meta-analysis to explore the impact of intraperitoneal levobupivacaine versus placebo on pain intensity after laparoscopic cholecystectomy. MATERIALS AND METHODS We searched the PubMed, Embase, Web of Science, EBSCO, and Cochrane Library databases through March 2019 for randomized controlled trials assessing the effect of intraperitoneal levobupivacaine versus placebo on pain intensity after laparoscopic cholecystectomy. This meta-analysis is performed using the random-effect model. RESULTS Six randomized controlled trials are included in the meta-analysis. Overall, compared with the control group after laparoscopic cholecystectomy, intraperitoneal levobupivacaine is associated with substantially reduced pain scores at 2 hours [standard mean difference (SMD)=-0.70; 95% confidence interval (CI)=-1.04 to -0.37; P<0.0001], 4 hours (SMD=-0.61; 95% CI=-0.90 to -0.32; P<0.0001), and 12 hours postoperatively (SMD=-0.31; 95% CI=-0.60 to -0.03; P=0.03), and analgesic requirement (SMD=-0.83; 95% CI=-1.48 to -0.19; P=0.01), but reveals no obvious impact on pain scores at 24 hours postoperatively (SMD=0.09; 95% CI=-0.64 to 0.83; P=0.80) and the incidence of nausea or vomiting (risk ratio=0.69; 95% CI=0.40-1.20; P=0.19). Total adverse events in the levobupivacaine group seem to be lower than that in the control group (risk ratio=0.57; 95% CI=0.38-0.85; P=0.006). CONCLUSION Intraperitoneal levobupivacaine provides additional benefits for pain relief after laparoscopic cholecystectomy.

The Impact of Intraperitoneal Levobupivacaine on Pain Relief After Laparoscopic Cholecystectomy: A Meta-analysis of Randomized Controlled Studies.

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The Impact of Intraperitoneal Levobupivacaine on Pain Relief After Laparoscopic Cholecystectomy: A Meta-analysis of Randomized Controlled Studies.