{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:23:01Z","timestamp":1785435781832,"version":"3.56.0"},"reference-count":133,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000038","name":"U.S. Food and Drug Administration","doi-asserted-by":"crossref","award":["U01FD008147"],"award-info":[{"award-number":["U01FD008147"]}],"id":[{"id":"10.13039\/100000038","id-type":"DOI","asserted-by":"crossref"}]},{"award":["U01FD008147"],"award-info":[{"award-number":["U01FD008147"]}],"id":[{"id":"https:\/\/ror.org\/034xvzb47","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Minnesota Evidence-Based Practice Center"},{"name":"University of Minnesota Center for Learning Health System Sciences"},{"id":[{"id":"https:\/\/ror.org\/017zqws13","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Effectively managing acute postoperative pain after laparoscopic surgery (M-PALS) is essential to optimize outcomes, enhance recovery, and mitigate opioid-related risks. We aimed to systematically map evidence on effectiveness and harms of pharmacologic and non-pharmacologic interventions for M-PALS. Methods: We searched three databases (2012\u20132025) for randomized clinical trials (RCTs) that reported postoperative opioid use and pain-related outcomes. We assessed study quality using the Cochrane Risk of Bias (ROB)-2 tool. Results: From 7638 citations, we included 101 RCTs. Postoperative opioid use was reported variably (e.g., total use over 24 or 48 h postoperatively, frequency of rescue-opioid use, and time to first rescue-opioid use). One out of 101 RCTs evaluated opioid prescription at discharge. No RCT reported opioid use at \u22653 months postoperatively. Eleven strategies were evaluated in \u22652 RCTs, with usual care\/ sham as comparators. None of the 101 RCTs favored usual care over any intervention for pain or opioid use outcomes. For regional anesthesia (21 RCTs total; 12 with low ROB), intraperitoneal\/preperitoneal local anesthetic instillation (10 RCTs; 4 with low ROB), intravenous dexamethasone (3 RCTs; 1 with low ROB), and the Enhanced Recovery After Surgery (ERAS) protocol (3 RCTs; 0 with low ROB), compared to usual care, &gt;50% of RCTs favored the intervention for reducing pain and opioid use. For adverse events, only 3 out of 101 RCTs favored comparators. Inconsistent outcome reporting across all RCTs and, for multimodal strategies, the uniqueness of intervention\u2013comparator combinations hindered comparisons. Conclusions: Interventions for M-PALS appear safe, with no RCT indicating worse efficacy of intervention than usual care; but evidence regarding superiority is conflicting. Future research should establish standardized and longer-term core outcome sets and make head-to-head comparisons between optimal strategies.<\/jats:p>","DOI":"10.3390\/jcm15082872","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T09:08:12Z","timestamp":1775812092000},"page":"2872","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evidence Map of Pharmacologic and Non-Pharmacologic Perioperative Strategies for Managing Acute Postoperative Pain After Laparoscopic Surgery, 2012\u20132025: The M-PALS Collaborative"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6087-0583","authenticated-orcid":false,"given":"Romil R.","family":"Parikh","sequence":"first","affiliation":[{"name":"School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA"},{"name":"Center for Learning Health System Sciences, University of Minnesota, Minneapolis, MN 55455, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8006-9325","authenticated-orcid":false,"given":"Gabriella L.","family":"Lott","sequence":"additional","affiliation":[{"name":"\u201cTwin Cities\u201d, University of Minnesota Medical School, Minneapolis, MN 55455, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miranda","family":"Considine","sequence":"additional","affiliation":[{"name":"Center for Learning Health System Sciences, University of Minnesota, Minneapolis, MN 55455, USA"},{"name":"Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Sawtell","sequence":"additional","affiliation":[{"name":"\u201cTwin Cities\u201d, University of Minnesota Medical School, Minneapolis, MN 55455, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sallee","family":"Brandt","sequence":"additional","affiliation":[{"name":"Center for Learning Health System Sciences, University of Minnesota, Minneapolis, MN 55455, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2420-5612","authenticated-orcid":false,"given":"Luz Angela","family":"Choconta-Piraquive","sequence":"additional","affiliation":[{"name":"School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Swathi","family":"Pagadala","sequence":"additional","affiliation":[{"name":"School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Drew J.","family":"Persson","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3996-1055","authenticated-orcid":false,"given":"Amy M.","family":"Claussen","sequence":"additional","affiliation":[{"name":"School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J.","family":"Tignanelli","sequence":"additional","affiliation":[{"name":"Center for Learning Health System Sciences, University of Minnesota, Minneapolis, MN 55455, USA"},{"name":"Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA"},{"name":"Institute for Health Informatics, University of Minnesota, Minneapolis, MN 55455, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Wilt","sequence":"additional","affiliation":[{"name":"Veterans Association Health Care System, Minneapolis, MN 55417, USA"},{"name":"Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5867-8741","authenticated-orcid":false,"given":"Shahnaz","family":"Sultan","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adalyn J.","family":"Scherer","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University of Minnesota, Minneapolis, MN 55455, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6671-962X","authenticated-orcid":false,"given":"Aaron","family":"Berg","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University of Minnesota, Minneapolis, MN 55455, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1685-0205","authenticated-orcid":false,"given":"Christie L.","family":"Martin","sequence":"additional","affiliation":[{"name":"School of Nursing, University of Minnesota, Minneapolis, MN 55455, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Wick","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California, San Francisco, CA 94143, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Genevieve B.","family":"Melton","sequence":"additional","affiliation":[{"name":"Center for Learning Health System Sciences, University of Minnesota, Minneapolis, MN 55455, USA"},{"name":"Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA"},{"name":"Institute for Health Informatics, University of Minnesota, Minneapolis, MN 55455, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary E.","family":"Butler","sequence":"additional","affiliation":[{"name":"School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA"},{"name":"Center for Learning Health System Sciences, University of Minnesota, Minneapolis, MN 55455, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9311-2671","authenticated-orcid":false,"given":"Bronwyn J.","family":"Southwell","sequence":"additional","affiliation":[{"name":"Center for Learning Health System Sciences, University of Minnesota, Minneapolis, MN 55455, USA"},{"name":"Department of Anesthesiology, University of Minnesota, Minneapolis, MN 55455, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1001\/archsurg.2012.195","article-title":"Laparoscopic vs open gastric bypass surgery: Differences in patient demographics, safety, and outcomes","volume":"147","author":"Banka","year":"2012","journal-title":"Arch. 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