Pain after Laparoscopic Cholecystectomy

Authors

  • Ali A. Dabbagh CABS, FICMS. Department of Surgery Rizgary Teaching Hospital and College of Medicine /HMU

DOI:

https://doi.org/10.15218/zjms.2009.017

Keywords:

Laparoscopic cholecystectomy (LC), postoperative pain, Verbal Rating Scale (VRS)

Abstract

Background and objective: Although laparoscopic cholecystectomy results in less pain than open cholecystectomy, it is not a pain free procedure. A clinical trial was designed to assess pain after LC in terms of types of pain, intensity and factors that may influence it.

Methods: A prospective study on pain was performed on all patients undergoing the operation over the period of 1.5 year (n = 150). Pain was measured by a five point verbal rating scale (VRS).

Results: Pain was the most frequent symptom, after the operation. The main type of postoperative pain was intra-abdominal 72%, followed by incisional 60% and shoulder pain 10%.The mean level of pain was 2.12 VRS points 8 h after the operation and declined to 1.01 points next day. In 54 patients (36%) the intensity of pain was higher than 2 VRS points. Female sex was the only predictor of pain intensity.

Conclusion: Laparoscopic cholecystectomy did cause significant postoperative pain in one-third of our patients only up to the first postoperative day. As predictors for high intensity of pain were not identified clearly, pain should be monitored and multimodal analgesics should be delivered accordingly.

Metrics

Metrics Loading ...

References

-Tsimoyiannis EC, Siakas P, Tassis A, Lekkas ET, Tzourou H, Kambili M . Intraperitoneal normal saline infusion for postoperative pain after laparoscopic cholecystectomy. World J Surg 1998; 22:824–8.

-Barut I, Tarhan O, Çerçi C, and Bülbül M. Experience of ambulatory laparoscopic cholecystectomy in Turkish patients. Eur J Gen Med 2005; 2(3):96-9.

-Wills VL, and Hunt DR .Pain after Laparoscopic cholecystectomy. Br J Surg 2000;87:273–84.

- Bisgaard T, Kehlet H, Rosenberg J. Pain and convalescence after Laparoscopic cholecystectomy. Eur J Surg 2001;167:84–96.

- Gupta A, Thorn SE, Axelsson K, Larsson LG, Agren G, Holmstrom B, Rawal N . Postoperative pain relief using intermittent injections of 0.5% ropivacaine through a catheter after Laparoscopic cholecystectomy. Anesth Analg 2002;95:450–6.

- Bisgaard T, Klarskov B, Rosenberg J, Kehlet H. Factors determining convalescence after uncomplicated Laparoscopic cholecystectomy. Arch Surg 2001;136:917–21.

- Robinson TN, Biffl WL, Moore EE, Heimbach JK, Calkins CM, Burch JM. Predicting failure of outpatient Laparoscopic cholecystectomy. Am J Surg 2002;184(2):515-9.

- Boddy A, Mehta S, and Rhodes M .The Effect of Intraperitoneal Local Anesthesia in Laparoscopic cholecystecotmy: A Systematic Review and Meta-Analysis. Anesth Analg 2006;103:682–8.

- Deirdre M, Sallyann C, Jackie R, McEntee G, Chambers F and Moriarty D .Intraperitoneal Pethidine versus Intramuscular Pethidine for the Relief of Pain after Laparoscopic cholecystectomy: World J. Surg 2002;26, 1432–6.

-Pourseidi B, Khorram-Manesh A . Effect of intercostals neural blockade with Marcaine (bupivacaine) on postoperative pain after Laparoscopic cholecystectomy, Surg Endosc 2007; 21: 1557–9.

- Barczyn´ski M, Herman R. M. Low pressure pneumoperitoneum combined with intraperitoneal saline washout for reduction of pain after Laparoscopic cholecystectomy: Surg. Endosc 2004; 18: 1368-73.

- Fiorillo MA, Davidson PG, Fiorillo M, D’Anna Jr. JA, Sithian N, Silich RJ. 149 ambulatory laparoscopic cholecystectomies. Surg Endosc 1996; 10: 52–6.

-Bisgaard T, Klarskov B, Kristiansen VB, Callesen T, Schulze S, Kehlet H et al. Multi-regional local anesthetic infiltration during laparoscopic cholecystectomy in patients receiving prophylactic multi-modal analgesia: a randomized, double-blinded, placebo-controlled study. Anesth Analg 1999; 89: 1017–24.

-Joris J, Thiry E, Paris P, Weerts J and Lamy M. Pain after laparoscopic cholecystectomy: characteristics and effect of intraperitoneal bupivacaine. Anesth Analg 2005; 81: 379–84.

-Lepner U, Goroshina J & Samarutel J. Postoperative pain relief after laparoscopic cholecystectomy: a randomized prospective double-blind clinical trial. Scand J Surg 2003; 92: 121–4.

- Mraovic B, Jurisic T, Kogler-Majeric V, Sustica A. Intraperitoneal bupivacaine for analgesia after laparoscopic cholecystectomy. Acta Anaesthesiol Scand 1997; 41: 193–6.

- Louizos A. A, Hadzilia S. J., Leandros E, Kouroukli I, Georgiou L and Bramis J.Postoperative pain relief after laparoscopic cholecystectomy A placebo-controlled double-blind randomized trial of preincisional infiltration and intraperitoneal instillation of levobupivacaine 0.25%,Surg Endosc 2005; 19: 1503–6.

- Nursal T, Yildirim S, Tarim A, Noyan T, Poyraz P,. Effect of drainage on postoperative nausea, vomiting, and pain after laparoscopic cholecystectomy. Langenbecks Arch Surg 2003; 388:95–100.

- Gupta A. Local anaesthesia for pain relief after laparoscopic cholecystectomy—a systematic review. Best Practice & Research Clinical Anaesthesiology 2005; 19(2): 275–92.

- Vezakis A, Davides D, Gibson JS, et al. Randomized comparison between low pressure laparoscopic cholecystectomy and gasless laparoscopic cholecystectomy. Surg Endosc 1999;13: 890–3.

Nayman J. Measurement and control of postoperative pain. Ann R Coll Surg Engl 1999; 61:419-24.

- Ure B, Troid L, Spangenberger F, Dietrich A et al. Pain after laparoscopic cholecystectomy. Surg Endosc 1994; 8:90-6.

- Uzunkoy A, Coskun A & Akinci OF. The value of pre-emptive analgesia in the treatment of postoperative pain after laparoscopic cholecystectomy. Eur Surg Res 2001; 33: 39–41.

- Jackson SA, Laurence AS, Hill JC. Does postlaparoscopy pain relate to residual carbon dioxide? Anaesthesia 2000; 5:485–7.

- Draper K, Jefson R, Jongeward R, McLeod M. Duration of postlaparoscopic pneumoperitoneum. Surg Endosc 1997;11:809–811.

- Pappas-Gogos G, Konstandinos Æ, Tsimogiannis E et al. Preincisional and intraperitoneal ropivacaine plus normal saline infusion for postoperative pain relief after laparoscopic cholecystectomy: a randomized double-blind controlled trial. Surg Endosc 2008; 22:2036–45.

Downloads

Published

2009-08-02

How to Cite

Dabbagh, A. A. (2009). Pain after Laparoscopic Cholecystectomy. Zanco Journal of Medical Sciences (Zanco J Med Sci), 13(2), 37–42. https://doi.org/10.15218/zjms.2009.017

Issue

Section

Original Articles