Volume 83, Issue 8 (November 2025)
Tehran Univ Med J 2025, 83(8): 558-566 |
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Kalani N, Sayadinia M, Pourdavood A H, Ziaei M, Zare T, Razavi B M et al . Effective non-opioid drugs for pain control in laparoscopic cholecystectomy surgery: a narrative review study. Tehran Univ Med J 2025; 83 (8) :558-566
URL: http://tumj.tums.ac.ir/article-1-13794-en.html
URL: http://tumj.tums.ac.ir/article-1-13794-en.html
Navid Kalani1 
, Mehrdad Sayadinia2 , Amir Hossein Pourdavood3 , Maryam Ziaei4 , Tayyebeh Zare5 , Bibi Mona Razavi5 , Mansour Deylami6
, Mehrdad Sayadinia2 , Amir Hossein Pourdavood3 , Maryam Ziaei4 , Tayyebeh Zare5 , Bibi Mona Razavi5 , Mansour Deylami6
1- Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran.
2- Department of Surgery, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
3- Department of Surgery, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
4- Department of Emergency Medicine, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran.
5- Department of Anesthesiology, Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
6- Department of Anesthesiology and Critical Care, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran.
2- Department of Surgery, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
3- Department of Surgery, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
4- Department of Emergency Medicine, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran.
5- Department of Anesthesiology, Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
6- Department of Anesthesiology and Critical Care, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran.
Abstract: (141 Views)
Background: With the rapid advancement of minimally invasive surgical techniques, laparoscopic cholecystectomy has become one of the most frequently performed procedures worldwide. Despite its benefits, such as reduced postoperative complications and faster recovery, effective pain management remains a critical challenge. Postoperative pain can significantly impact patient recovery, hospital stay duration, and overall satisfaction. Given the limitations and side effects of opioid-based analgesics, there is growing interest in non-opioid alternatives for pain control following laparoscopic cholecystectomy. This narrative review evaluates the efficacy of various non-opioid analgesics in managing postoperative pain in patients undergoing this procedure.
Methods: A comprehensive literature search was conducted across multiple electronic databases, including Scopus, PubMed, Science Direct, SID, Magiran, and Google Scholar, using both Persian and English keywords. English equivalents were "Pain" and "Laparoscopic Cholecystectomy." Studies discussing pharmacological interventions for postoperative pain management in laparoscopic cholecystectomy were included.
Results: The review identified a wide range of non-opioid analgesics used for pain control in laparoscopic cholecystectomy patients. These included: Systemic medications (intravenous/oral) were magnesium sulfate, ketamine, ketorolac, paracetamol, ibuprofen, pregabalin, gabapentin, acetazolamide, N-acetylcysteine, dexamethasone, clonidine, celecoxib, and diclofenac. Local anesthetics & adjuvants were used intraperitoneally like bupivacaine, lidocaine, and hydrocortisone. Administration routes varied, with most drugs given intravenously, intraperitoneally, or preemptively (e.g., celecoxib and clonidine before surgery). Some studies highlighted the benefits of multimodal analgesia, combining different drug classes to enhance pain relief while minimizing side effects.
Conclusion: Despite the availability of numerous non-opioid analgesics, no single drug has been universally endorsed as the gold standard for postoperative pain management in laparoscopic cholecystectomy. Current evidence suggests that the choice of analgesic should be individualized, considering patient factors (e.g., comorbidities, pain tolerance) and the anesthesiologist’s expertise. Multimodal approaches, combining different drug classes, may offer superior pain control with fewer adverse effects compared to monotherapy. Further high-quality randomized trials are needed to establish standardized protocols and optimize pain management strategies for these patients.
Methods: A comprehensive literature search was conducted across multiple electronic databases, including Scopus, PubMed, Science Direct, SID, Magiran, and Google Scholar, using both Persian and English keywords. English equivalents were "Pain" and "Laparoscopic Cholecystectomy." Studies discussing pharmacological interventions for postoperative pain management in laparoscopic cholecystectomy were included.
Results: The review identified a wide range of non-opioid analgesics used for pain control in laparoscopic cholecystectomy patients. These included: Systemic medications (intravenous/oral) were magnesium sulfate, ketamine, ketorolac, paracetamol, ibuprofen, pregabalin, gabapentin, acetazolamide, N-acetylcysteine, dexamethasone, clonidine, celecoxib, and diclofenac. Local anesthetics & adjuvants were used intraperitoneally like bupivacaine, lidocaine, and hydrocortisone. Administration routes varied, with most drugs given intravenously, intraperitoneally, or preemptively (e.g., celecoxib and clonidine before surgery). Some studies highlighted the benefits of multimodal analgesia, combining different drug classes to enhance pain relief while minimizing side effects.
Conclusion: Despite the availability of numerous non-opioid analgesics, no single drug has been universally endorsed as the gold standard for postoperative pain management in laparoscopic cholecystectomy. Current evidence suggests that the choice of analgesic should be individualized, considering patient factors (e.g., comorbidities, pain tolerance) and the anesthesiologist’s expertise. Multimodal approaches, combining different drug classes, may offer superior pain control with fewer adverse effects compared to monotherapy. Further high-quality randomized trials are needed to establish standardized protocols and optimize pain management strategies for these patients.
Keywords: laparoscopic cholecystectomy, non-opioid analgesics, pain, postoperative pain management, surgery.
Type of Study: Review Article |
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