Abstract
Hepatocellular carcinoma (HCC) is a common primary liver malignancy, but only 20-30% of patients qualify for resection due to tumor stage and liver function. Postoperative wound pain is a critical concern that can impact patient recovery and hospital stay duration. This systematic review and meta-analysis assess the efficacy of multimodal analgesia (MMA) in managing postoperative pain following hepatectomy for HCC. Adhering to PRISMA guidelines, a comprehensive search was conducted across PubMed, Embase, Web of Science, and the Cochrane Library, identifying relevant randomized controlled trials (RCTs) without language or publication date restrictions. The inclusion criteria focused on adult patients with HCC undergoing hepatectomy, comparing the effects of MMA with standard pain management protocols. Primary outcomes included postoperative pain intensity, and adverse events, with secondary outcomes addressing hospital stay duration. Quality assessment utilized the Cochrane Collaboration's risk of bias tool, and a fixed or random-effects model was applied based on heterogeneity levels. Ten RCTs met the inclusion criteria, demonstrating MMA's significant reduction in postoperative pain scores (weighted mean difference [WMD] = - 1.08, P < 0.001) and hospital stay duration (WMD = - 1.19 days, P < 0.01), with a lower incidence of adverse events (RR = 0.63, P < 0.01). Sensitivity analysis confirmed the robustness of these findings, and no significant publication bias was detected. This meta-analysis shows that MMA effectively reduces postoperative pain, adverse events, and hospital stay in hepatectomy patients, including both open and laparoscopic procedures. Future studies should explore long-term outcomes and recovery optimization.Trial registration: CRD42024605076.