A non-pharmacological intraoperative intervention to reduce pain and enhance recovery following laparoscopic cholecystectomy: a randomised controlled trial

Abstract

Introduction: Non-pharmacological strategies are gaining interest in perioperative care to improve recovery and reduce opioid dependence. This study was designed to evaluate the impact of intraoperative religious chanting on postoperative pain, opioid consumption, and early mobilisation in patients undergoing laparoscopic cholecystectomy.Methodology: A prospective, double-blinded randomised controlled trial was conducted involving 60 patients scheduled for elective laparoscopic cholecystectomy at a single tertiary centre. Participants were randomised to receive either religious chanting (n = 30) or silence (control, n = 30) through headphones intraoperatively. The primary outcome was postoperative pain measured using the Visual Analogue Scale (VAS) at 6, 12, and 24 hours. Secondary outcomes included cumulative opioid requirement, early mobilisation (within 6 hours), and incidence of postoperative nausea and vomiting (PONV).Results: Patients exposed to religious chanting had significantly lower VAS pain scores at 6 hours (3.2 vs. 4.7, p<0.01), 12 hours (2.7 vs. 4.1, p=0.01), and 24 hours (1.8 vs. 3.2, p=0.03). Mean total opioid consumption was reduced by 35% in the chanting group (p=0.02). Early mobilisation was achieved in 70% of the chanting group compared to 43% in controls (p=0.04). No significant difference was observed in PONV rates.Conclusion: Intraoperative religious chanting is a safe, low-cost, and effective adjunct to reduce postoperative pain and opioid use, and to enhance early recovery in laparoscopic cholecystectomy. These findings support the integration of culturally appropriate non-pharmacological interventions into multimodal perioperative care protocols.Sri Lanka clinical trial registry (Reference Number: SLCTR/2024/031)