Pain after laparoscopic cholecystectomy

Br J Surg. 2000 Mar;87(3):273-84. doi: 10.1046/j.1365-2168.2000.01374.x.

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.

Publication types

  • Review

MeSH terms

  • Anesthesia, Local
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Cholecystectomy, Laparoscopic / adverse effects*
  • Clinical Trials as Topic
  • Humans
  • Insufflation
  • Pain Measurement
  • Pain, Postoperative / etiology*
  • Pain, Postoperative / physiopathology
  • Pain, Postoperative / prevention & control
  • Sodium Chloride / administration & dosage

Substances

  • Anti-Inflammatory Agents, Non-Steroidal
  • Sodium Chloride