腹腔鏡下胆嚢摘出術後の疼痛管理における非薬理学的介入の効果：系統的レビューおよびネットワークメタアナリシス

Although non-pharmacological interventions are widely utilized for postoperative pain management, their comparative effectiveness remains unclear. This network meta-analysis (NMA) aimed to comprehensively evaluate the effects of various non-pharmacological interventions on postoperative pain and anxiety after LC, and to identify the optimal intervention through ranking analysis.

A literature search was executed to identify relevant randomized controlled trials (RCTs) that investigated non-pharmacological interventions for alleviating pain after laparoscopic cholecystectomy (LC). This search encompassed the electronic databases PubMed, Web of Science, Embase, CINAHL, and the Cochrane Library, with the coverage spanning from the inception of each database to January 2025. Two independent reviewers performed literature search, study selection, quality assessment, and data extraction. The Cochrane Risk of Bias 2.0 tool was employed for bias assessment. A Bayesian NMA was conducted, with surface under the cumulative ranking curve (SUCRA) values used to rank intervention effectiveness.

The review identified 15 types of non-pharmacological interventions. The most common among these were acupressure (n=5), massage (n=4), and transcutaneous electrical nerve stimulation (TENS, n=2). The NMA demonstrated that ear acupressure, aromatherapy, and foot baths ranked as the top three interventions for alleviating postoperative pain after LC. Compared with standard care, all three interventions significantly improved pain scores: ear acupressure (standardized mean difference [SMD] = -3.61, 95% credible interval [CrI] -5.71 to -1.50), essential oil therapy (SMD = -2.59, 95% CrI -4.93 to -0.27), and foot baths (SMD = -2.42, 95% CrI -4.67 to -0.19). SUCRA rankings revealed ear acupressure (93.93%) as the most effective intervention, followed by essential oil therapy (80.97%) and foot baths (78.46%). None of the evaluated non-pharmacological interventions demonstrated statistically significant effects on anxiety reduction.

Multiple non-pharmacological interventions can effectively alleviate postoperative pain after LC. However, none of the evaluated interventions produced statistically significant reductions in postoperative anxiety.