Effects of Adding Local Anesthesia to General Anesthesia on Postoperative Analgesia in Patients Undergoing Laparoscopic Cholecystectomy: A Retrospective Cohort Study

Objective: Postoperative pain remains a significant concern following laparoscopic cholecystectomy (LC). This study aimed to evaluate the effects of wound infiltration and intraperitoneal instillation of local anesthetics on postoperative analgesia. Methods: This retrospective cohort study included 202 patients undergoing elective LC under standardized balanced general anesthesia between February 2023 and July 2025. Patients were divided into three groups based on the analgesic protocols they received: control group (Group C, n=54) receiving general anesthesia with routine patient-controlled intravenous analgesia (PCIA), local infiltration group (Group L, n=73) receiving additional wound infiltration with ropivacaine, and combined group (Group CL, n=75) receiving wound infiltration plus intraperitoneal instillation. The primary outcome was Visual Analogue Scale (VAS) scores at rest and during movement. Secondary outcomes included rescue analgesia use, PCIA utilization, referred shoulder pain, time to first ambulation, postoperative hospital stay, adverse events, and patient satisfaction. Results: Group CL demonstrated significantly lower VAS scores at rest and during movement at all time points compared with Group L and Group C (all P < 0.001). The incidence of referred shoulder pain was significantly different among the three groups ( P =0.032), with Group CL showing the lowest incidence. Time to first ambulation and postoperative hospital stay were significantly reduced in Group CL ( P < 0.001 and P =0.023, respectively). Patient satisfaction scores were significantly higher in Group CL ( P =0.004). No significant differences in adverse events were observed among the three groups. Conclusion: The combination of wound infiltration and intraperitoneal instillation of ropivacaine is associated with improved postoperative analgesia and facilitates early recovery in patients undergoing LC. Keywords: cholecystectomy, laparoscopic, anesthetics, local, pain, postoperative, ropivacaine, analgesia, patient-controlled