# Efficacy and safety of hydromorphone for preemptive analgesia in patients undergoing laparoscopic cholecystectomy: a systematic review and meta-analysis

## TL;DR

This study finds that hydromorphone, an opioid, is effective and safe for reducing post-surgery pain in patients undergoing laparoscopic cholecystectomy.

## Contribution

The study provides a systematic review and meta-analysis confirming hydromorphone's efficacy and safety as a preemptive analgesic in laparoscopic cholecystectomy patients.

## Key findings

- Hydromorphone significantly reduced postoperative pain intensity and improved hemodynamic stability.
- It shortened extubation time and reduced emergence agitation compared to controls.
- Hydromorphone decreased inflammatory markers like IL-1, IL-8, and TNF-α without increasing nausea or vomiting.

## Abstract

Laparoscopic 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.

A 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.

Seventeen 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.

The outcomes of this study substantiate the efficacy and safety of hydromorphone in the management of postoperative pain, demonstrating superiority over placebo or no treatment.