SynthesisBMC anesthesiology2025
Efficacy and safety of hydromorphone for preemptive analgesia in patients undergoing laparoscopic cholecystectomy: a systematic review and meta-analysis.
Synthesis in BMC anesthesiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundLaparoscopic cholecystectomy (LC) is a widely adopted minimally invasive procedure for the treatment of gallbladder diseases. However, postoperative pain remains a significant clinical challenge, with more than 30% of patients experiencing moderate to severe pain, which may prolong hospital stays and impede enhanced recovery after surgery (ERAS) protocols. Hydromorphone, a potent semisynthetic opioid with rapid onset and prolonged analgesic effects, has been employed for preemptive analgesia in LC. This agent has greater analgesic potency and a potentially more favourable side effect profile than morphine does. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of hydromorphone as a preemptive analgesic in patients undergoing LC.
methodsA comprehensive literature search was conducted across multiple databases, including PubMed, Cochrane, Embase, Web of Science, CNKI, VIP, Wanfang Data, and CBM, from their inception to 2025. Studies assessing the efficacy and safety of hydromorphone for pre-emptive analgesia in LC recipients were included. Additional relevant publications were identified by reviewing references from retrieved articles and searching for commercial system names. Meta-analyses were performed using fixed- or random-effects models on the basis of heterogeneity levels.
resultsSeventeen studies involving a total of 1,515 patients (hydromorphone group, n = 761; control group, n = 754) were included. The control group received either normal saline or no treatment. Compared with controls, patients treated with hydromorphone presented significantly decreased pain intensity at multiple postoperative time points (P < 0.05); shortened extubation time (P < 0.05); a reduced incidence of emergence agitation (P < 0.05); and improved haemodynamic stability, as evidenced by reduced numbers of fluctuations in heart rate and mean arterial pressure (P < 0.05). Additionally, hydromorphone was associated with decreased levels of inflammatory markers (IL-1, IL-8, and TNF-α; P < 0.05). No significant difference was observed in the incidence of postoperative nausea and vomiting (PONV) between the two groups.
conclusionThe outcomes of this study substantiate the efficacy and safety of hydromorphone in the management of postoperative pain, demonstrating superiority over placebo or no treatment.
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