V L Wills1, D R Hunt. 1. Upper Gastrointestinal Surgical Unit, Level 5, Suite 1, St George Private Medical Centre, South Street, Kogarah, 2217 New South Wales, Australia.
Abstract
BACKGROUND: Although laparoscopic cholecystectomy (LC) results in less pain than open chole-cystectomy, it is not a pain-free procedure. Many methods of analgesia for pain after laparoscopy have been evaluated. METHODS: Forty-two randomized controlled trials assessing interventions to reduce pain after LC are reviewed, as are the mechanisms and nature of pain after this procedure. RESULTS: Non-steroidal anti-inflammatory drugs, wound local anaesthetic, intraperitoneal local anaesthetic, intraperitoneal saline, a gas drain, heated gas, low-pressure gas and nitrous oxide pneumo-peritoneum have been shown to reduce pain after LC. The clinical significance of this pain reduction is questionable. CONCLUSION: Pain after LC is multifactorial. Although many methods of analgesia produce short-term benefit, this does not equate with earlier discharge or improved postoperative function. However, single trials evaluating low-pressure insufflation, heated gas and multimodal analgesia suggest that clinically relevant benefits can be achieved.
BACKGROUND: Although laparoscopic cholecystectomy (LC) results in less pain than open chole-cystectomy, it is not a pain-free procedure. Many methods of analgesia for pain after laparoscopy have been evaluated. METHODS: Forty-two randomized controlled trials assessing interventions to reduce pain after LC are reviewed, as are the mechanisms and nature of pain after this procedure. RESULTS: Non-steroidal anti-inflammatory drugs, wound local anaesthetic, intraperitoneal local anaesthetic, intraperitoneal saline, a gas drain, heated gas, low-pressure gas and nitrous oxide pneumo-peritoneum have been shown to reduce pain after LC. The clinical significance of this pain reduction is questionable. CONCLUSION:Pain after LC is multifactorial. Although many methods of analgesia produce short-term benefit, this does not equate with earlier discharge or improved postoperative function. However, single trials evaluating low-pressure insufflation, heated gas and multimodal analgesia suggest that clinically relevant benefits can be achieved.
Authors: H Kehlet; A W Gray; F Bonnet; F Camu; H B J Fischer; R F McCloy; E A M Neugebauer; M M Puig; N Rawal; C J P Simanski Journal: Surg Endosc Date: 2005-08-11 Impact factor: 4.584
Authors: B D Straub; A Aslani; K Enohumah; R Rahore; I Conrick-Martin; D Kumar; M Campbell; P Dicker; E Mocanu; J P Loughrey; N E Hayes; C L McCaul Journal: Ir J Med Sci Date: 2013-12-10 Impact factor: 1.568