SYSTEMATIC REVIEW article
Front. Pharmacol.
Sec. Neuropharmacology
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1646917
The effect of intraperitoneal instillation of drugs on postoperative analgesia after laparoscopic cholecystectomy: a network meta-analysis
Provisionally accepted
- Affiliated Dazu's Hospital of Chongqing Medical University, Chongqing, China
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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 hours post-surgery. Acetazolamide (85.9%) was most effective at 12 hours, MgSO₄ (98.4%) at 6 hours, and ondansetron (96.4%) at 2 hours. Dexamethasone was associated with the lowest analgesic consumption (SUCRA: 95.3%) and the longest time to first analgesic request (81.5%). Conclusions: 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.
Keywords: intraperitoneal, laparoscopic cholecystectomy, Postoperative analgesia, Drug intervention, Network meta-analysis
Received: 14 Jun 2025; Accepted: 27 Aug 2025.
Copyright: © 2025 Zhang, Wang, Yang and Xia. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Dajian Xia, Affiliated Dazu's Hospital of Chongqing Medical University, Chongqing, China
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