{"title":"The effect of intraperitoneal instillation of drugs on postoperative analgesia after laparoscopic cholecystectomy: a network meta-analysis.","authors":"Dongmei Zhang, Xiaojiao Wang, Xiaoli Yang, Dajian Xia","doi":"10.3389/fphar.2025.1646917","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Postoperative pain is a critical factor contributing to delayed discharge and postoperative recovery after laparoscopic cholecystectomy (LC). Intraperitoneal instillation of analgesic agents has been proposed as a means to alleviate pain in patients undergoing LC. This study aimed to evaluate the efficacy of various drugs administered via intraperitoneal instillation for postoperative analgesia after LC using a network meta-analysis approach.</p><p><strong>Methods: </strong>A comprehensive search was conducted in PubMed, EMbase, Web of Science and Cochrane Library databases from inception to August, 2025. Randomized controlled trials (RCTs) investigating the effects of intraperitoneal instillation on post-LC analgesia were included. Two independent reviewers screened studies, extracted data, and assessed the risk of bias. A frequentist network meta-analysis was performed to estimate standardized mean differences (SMDs) and 95% confidence intervals (CIs). The surface under the cumulative ranking curve (SUCRA) was used to rank the interventions for each outcome.</p><p><strong>Results: </strong>Eleven RCTs comprising 667 patients were included. According to SUCRA values, bicarbonate (96.5%) ranked highest in reducing VAS scores at 24 h post-surgery. Acetazolamide (85.9%) was most effective at 12 h, MgSO<sub>4</sub> (98.4%) at 6 h, and ondansetron (96.4%) at 2 h. Dexamethasone was associated with the lowest analgesic consumption (SUCRA: 95.3%) and the longest time to first analgesic request (81.5%).</p><p><strong>Conclusion: </strong>Intraperitoneal instillation of bicarbonate, acetazolamide, MgSO<sub>4</sub>, and ondansetron provides differential analgesic benefits at various time points after LC. Dexamethasone appears to be a promising adjunctive agent for reducing analgesic requirements and prolonging the duration of analgesia.</p>","PeriodicalId":12491,"journal":{"name":"Frontiers in Pharmacology","volume":"16 ","pages":"1646917"},"PeriodicalIF":4.8000,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463911/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Frontiers in Pharmacology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3389/fphar.2025.1646917","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Postoperative pain is a critical factor contributing to delayed discharge and postoperative recovery after laparoscopic cholecystectomy (LC). Intraperitoneal instillation of analgesic agents has been proposed as a means to alleviate pain in patients undergoing LC. This study aimed to evaluate the efficacy of various drugs administered via intraperitoneal instillation for postoperative analgesia after LC using a network meta-analysis approach.
Methods: A comprehensive search was conducted in PubMed, EMbase, Web of Science and Cochrane Library databases from inception to August, 2025. Randomized controlled trials (RCTs) investigating the effects of intraperitoneal instillation on post-LC analgesia were included. Two independent reviewers screened studies, extracted data, and assessed the risk of bias. A frequentist network meta-analysis was performed to estimate standardized mean differences (SMDs) and 95% confidence intervals (CIs). The surface under the cumulative ranking curve (SUCRA) was used to rank the interventions for each outcome.
Results: Eleven RCTs comprising 667 patients were included. According to SUCRA values, bicarbonate (96.5%) ranked highest in reducing VAS scores at 24 h post-surgery. Acetazolamide (85.9%) was most effective at 12 h, MgSO4 (98.4%) at 6 h, and ondansetron (96.4%) at 2 h. Dexamethasone was associated with the lowest analgesic consumption (SUCRA: 95.3%) and the longest time to first analgesic request (81.5%).
Conclusion: Intraperitoneal instillation of bicarbonate, acetazolamide, MgSO4, and ondansetron provides differential analgesic benefits at various time points after LC. Dexamethasone appears to be a promising adjunctive agent for reducing analgesic requirements and prolonging the duration of analgesia.
背景：术后疼痛是影响腹腔镜胆囊切除术（LC）后延迟出院和术后恢复的关键因素。腹腔内注射止痛剂已被提出作为减轻LC患者疼痛的一种手段。本研究旨在通过网络荟萃分析的方法，评估不同药物经腹腔注射用于LC术后镇痛的疗效。方法：综合检索PubMed、EMbase、Web of Science和Cochrane Library数据库，检索时间为成立至2025年8月。纳入随机对照试验（RCTs），研究腹腔内滴注对lc后镇痛的影响。两名独立审稿人筛选研究、提取数据并评估偏倚风险。采用频率网络元分析来估计标准化平均差异（SMDs）和95%置信区间（ci）。累积排序曲线下的曲面（SUCRA）用于对每个结果的干预措施进行排序。结果：纳入11项随机对照试验，共667例患者。根据SUCRA值，碳酸氢盐（96.5%）在降低术后24 h VAS评分方面排名最高。乙酰唑胺（85.9%）在12 h时最有效，MgSO4（98.4%）在6 h时最有效，昂丹司琼（96.4%）在2 h时最有效。地塞米松与最低的镇痛消耗（SUCRA: 95.3%）和最长的首次镇痛时间（81.5%）相关。结论：腹腔注射碳酸氢盐、乙酰唑胺、MgSO4和昂丹司琼在LC后不同时间点具有不同的镇痛效果。地塞米松似乎是一种很有前途的辅助药物，可以减少镇痛需求和延长镇痛时间。
期刊介绍：
Frontiers in Pharmacology is a leading journal in its field, publishing rigorously peer-reviewed research across disciplines, including basic and clinical pharmacology, medicinal chemistry, pharmacy and toxicology. Field Chief Editor Heike Wulff at UC Davis is supported by an outstanding Editorial Board of international researchers. This multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide.
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