Analgesia for minimal access abdominal surgery: addressing the visceral wound

Postoperative analgesia in adults undergoing minimal access abdominal surgery involves autonomic or visceral injury. Although minimal access surgery reduces somatic pain, peritoneal inflammation and consequent visceral pain remain major drivers of postoperative physiology and recovery. Nonsteroidal anti-inflammatory drugs and corticosteroids are proved, critical components of visceral analgesia and should form the foundation of any regimen addressing the visceral wound. Intraperitoneal local anaesthetic instillation offers a complementary visceral pain-targeted adjunct, reducing visceral pain scores, opioid consumption, and delays in gastrointestinal recovery. As the somatic wound continues to decrease in size, we argue for a paradigm shift in analgesic regimes toward visceral pain-targeted approaches, positioning intraperitoneal local anaesthetic instillation as a key adjunct within enhanced recovery pathways and identifying priorities for future research on the optimisation of delivery methods and patient-reported outcomes.