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The following is a summary of “Efficacy and Safety of Different Preemptive Analgesia Measures in Pain Management after Laparoscopic Cholecystectomy: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials,” published in the September 2024 issue of Pain  by Cao et al.

Researchers conducted a retrospective study to assess the efficacy and safety of various analgesia measures administered before laparoscopic cholecystectomy (LC) for managing patients with postoperative pain.

They conducted a comprehensive search of databases, including PubMed, Web of Science, Embase, and the Cochrane Library up to March 2024, and collected data on the 26 preemptive analgesia measures defined for laparoscopic surgery. Outcomes included postoperative Visual Analogue Scores (VAS) at different times (2, 6, 12, and 24 hours), opioid consumption within 24 hours post-operation, time to first rescue analgesia, the incidence of postoperative nausea and vomiting (PONV), and incidence of postoperative headache or dizziness.

The results revealed 49 articles involving 5,987 patients, showing multimodal analgesia, nerve blocks, pregabalin, and gabapentin decreased postoperative pain scores at all postoperative time points and reduced postoperative opioid consumption compared to placebo. Tramadol, pregabalin, and gabapentin prolonged the time first to rescue analgesia. Ibuprofen was recognized as the most adequate intervention for declining the incidence of PONV. Tramadol remarkably downsized the incidence of postoperative headache or dizziness. Subgroup analysis of different doses of pregabalin and gabapentin exhibited that, compared to placebo, pregabalin (300 mg, 150 mg) and gabapentin (600 mg, 300 mg, and 20 mg/kg) were all effective, with no notable differences in effectiveness between these doses. Higher doses were associated with an improved incidence of PONV and postoperative headache and dizziness, with gabapentin 300 mg showing a lower incidence of adverse drug reactions (ADRs).

They concluded that preemptive analgesia significantly improved postoperative pain management by reducing pain intensity, opioid consumption, and the incidence of adverse events. Multimodal analgesia, nerve blocks, pregabalin, and gabapentin were adequate, with gabapentin 300 mg being particularly promising for preemptive analgesia in laparoscopic surgery.

Source: link.springer.com/article/10.1007/s40122-024-00647-w