Pain management after laparoscopic cholecystectomy: A systematic review and procedure-specific postoperative pain management (PROSPECT) recommendations

Paracetamol + NSAIDs or COX-2 inhibitors pre- or intra-operatively, unless contraindicated

Intra-operative i.v. dexamethasone, port-site wound infiltration or intraperitoneal local anaesthetic instillation recommended; opioids for rescue analgesia

Second-line: ESP block or TAP block may be reserved for patients at heightened risk of postoperative pain

Recommended surgical technique: three-port laparoscopy, low-pressure pneumoperitoneum, umbilical port extraction, active aspiration of pneumoperitoneum, saline irrigation

Not recommended (limited or no evidence of improved pain scores): single port or mini-port techniques, routine drainage, low flow insufflation, natural orifice transluminal endoscopic surgery (NOTES), infra-umbilical incision, i.v. clonidine, nefopam, QL block, rectus sheath block

Not recommended due to risk of side effects despite better pain scores: spinal or epidural anaesthesia, gabapentinoids, i.v. lidocaine, i.v. ketamine, i.v. dexmedetomidine