Effectiveness of multimodal analgesic regimen versus standard care during laparoscopic cholecystectomy: A randomised controlled trial.

INTRODUCTION

Laparoscopic cholecystectomy is associated with significant post-operative pain, often hindering same-day discharge. Multimodal analgesia (MMA) combining non-opioid agents is advocated to address this challenge, yet standardised protocols remain elusive. This trial evaluates the efficacy of a structured MMA regimen versus standard care (SOC) in reducing pain, opioid use and surgical stress.

PATIENTS AND

METHODS

This randomised controlled trial enrolled 121 patients undergoing laparoscopic cholecystectomy, assigning 60 to standard care and 61 to MMA. The MMA group received intraoperative 0.5% ropivacaine at incision sites, gall bladder fossa and subdiaphragmatic region. The primary outcome was 24-h post-operative pain intensity, measured using the Visual Analogue Scale (VAS). The secondary outcomes included rescue analgesia requirements, inflammatory markers such as C-reactive protein (CRP), cortisol, interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-α). Intention-to-treat and per-protocol analyses were conducted using the Mann-Whitney U -test, the Chi-square test and linear mixed-effects models.

RESULTS

MMA significantly reduced median VAS scores by 40% at 3 h (5 [Interquartile range: 4-8] vs. 9 [8-10], P < 0.001, effect size r = 0.61) and 20% at 24 h (3 [1-4] vs. 5 [4-6], P < 0.001, r = 0.49). Rescue analgesia use was 63% lower in the MMA group (67.2% vs. 85%, odds ratio = 0.37, P = 0.02). Inflammatory markers - CRP and cortisol were significantly reduced in the MMA group, while IL-6 and TNF-α showed no differences at the 24 h post-operative period.

CONCLUSION

The MMA regimen effectively reduces post-operative pain, opioid reliance and surgical stress in laparoscopic cholecystectomy, aligning with enhanced recovery protocols. The attenuation of CRP and cortisol highlights MMA's anti-inflammatory benefits.