{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:43:59Z","timestamp":1787071439223,"version":"build-2736575974"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"Abstract<\/jats:title>\n \n Introduction:<\/jats:title>\n Laparoscopic cholecystectomy is associated with significant post-operative pain, often hindering same-day discharge. Multimodal analgesia (MMA) combining non-opioid agents is advocated to address this challenge, yet standardised protocols remain elusive. This trial evaluates the efficacy of a structured MMA regimen versus standard care (SOC) in reducing pain, opioid use and surgical stress.<\/jats:p>\n <\/jats:sec>\n \n Patients and Methods:<\/jats:title>\n \n This randomised controlled trial enrolled 121 patients undergoing laparoscopic cholecystectomy, assigning 60 to standard care and 61 to MMA. The MMA group received intraoperative 0.5% ropivacaine at incision sites, gall bladder fossa and subdiaphragmatic region. The primary outcome was 24-h post-operative pain intensity, measured using the Visual Analogue Scale (VAS). The secondary outcomes included rescue analgesia requirements, inflammatory markers such as C-reactive protein (CRP), cortisol, interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-\u03b1). Intention-to-treat and per-protocol analyses were conducted using the Mann\u2013Whitney\n U<\/jats:italic>\n -test, the Chi-square test and linear mixed-effects models.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n MMA significantly reduced median VAS scores by 40% at 3 h (5 [Interquartile range: 4\u20138] vs. 9 [8\u201310],\n P<\/jats:italic>\n < 0.001, effect size\n r<\/jats:italic>\n = 0.61) and 20% at 24 h (3 [1\u20134] vs. 5 [4\u20136],\n P<\/jats:italic>\n < 0.001,\n r<\/jats:italic>\n = 0.49). Rescue analgesia use was 63% lower in the MMA group (67.2% vs. 85%, odds ratio = 0.37,\n P<\/jats:italic>\n = 0.02). Inflammatory markers \u2013 CRP and cortisol were significantly reduced in the MMA group, while IL-6 and TNF-\u03b1 showed no differences at the 24 h post-operative period.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n The MMA regimen effectively reduces post-operative pain, opioid reliance and surgical stress in laparoscopic cholecystectomy, aligning with enhanced recovery protocols. The attenuation of CRP and cortisol highlights MMA\u2019s anti-inflammatory benefits.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/jmas.jmas_317_25","type":"journal-article","created":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T10:00:09Z","timestamp":1763978409000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Effectiveness of multimodal analgesic regimen versus standard care during laparoscopic cholecystectomy: A randomised controlled trial"],"prefix":"10.4103","author":[{"given":"Mayank","family":"Badkur","sequence":"first","affiliation":[{"name":"Department of Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seema","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Gandhi Medical College, Bhopal, Madhya Pradesh, 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