Purpose <p>Postoperative acute pain is a major obstacle to archiving key goals in modern perioperative treatment concepts such as ERAS® (enhanced recovery after surgery). Despite a multimodal pain management concept, some patients continue to suffer from severe pain. The aim of this analysis is to identify predictors of severe postoperative pain following elective minimally invasive intestinal surgery.</p> Methods <p>Data from 49 patients, who underwent intestinal resection between April 2021 and March 2022 were used for this purpose. Various pre- and intraoperative characteristics were examined for their influence on pain in the morning in a univariate and multivariate analysis. Increased postoperative pain is defined by a NRS (numerical rating scale) of at least 4 at rest.</p> Results <p>It was found that patients with severe postoperative pain (<i>n</i> = 16) on the first postoperative day (POD) had a significantly higher BDI (Beck Depression Index) score of 16.1 (± 10.46) compared to patients without severe postoperative pain (<i>n</i> = 33) with 8.89 (± 7.03) (<i>p</i> = 0.007). In the multivariate analysis, the BDI score was also significant with an Odds Ratio of 1.14 (CI 95% 1.02-1.29, <i>p</i> = 0.002). On POD 2, patients with increased pain (<i>n</i> = 10) were significantly younger (53.1 years (± 16.40)) than patients without increased pain (<i>n</i> = 39) (65.8 years (± 12.64)) (<i>p</i> = 0.01). This was also confirmed in the multivariate analysis with an Odds Ratio of 1.12 (CI 95% 1.02-1.24, <i>p</i> = 0.019).</p> Conclusion <p>It was demonstrated that a younger age, higher BDI score and the presence of IBD are significant predictors of severe postoperative pain despite multimodal pain management.</p>