A comparative study on postoperative pain relief in laparoscopic cholecystectomy: Intraperitoneal bupivacaine versus combination of bupivacaine and buprenorphine Evidence‐based management of pain after laparoscopic cholecystectomy: a PROSPECT review update Minimizing ports to improve laparoscopic cholecystectomy Laparoscopic versus minilaparotomy cholecystectomy: a randomised trial Short-term outcomes of single-site robotic cholecystectomy versus four-port laparoscopic cholecystectomy: a prospective, randomized, double-blind trial Laparoscopic versus open cholecystectomy: Hospitalization, sick leave, analgesia and trauma responses Anesthetic therapy for acute pain relief after laparoscopic cholecystectomy: systematic review. Laparoendoscopic single site (LESS) versus classic video-laparoscopic cholecystectomy: a randomized prospective study. A prospective randomized trial on comparison of low-pressure (LP) and standard-pressure (SP) pneumoperitoneum for laparoscopic cholecystectomy Prospective Randomized Trial on Low-pressure Versus Standard-pressure Pneumoperitoneum in Outpatient Laparoscopic Cholecystectomy Different pain scores in single transumbilical incision laparoscopic cholecystectomy versus classic laparoscopic cholecystectomy: a randomized controlled trial Active Gas Aspiration to Reduce Pain After Laparoscopic Cholecystectomy Randomized Comparison Between Different Insufflation Pressures for Laparoscopic Cholecystectomy Intraperitoneal Ropivacaine Nebulization for Pain Management After Laparoscopic Cholecystectomy: A Comparison with Intraperitoneal Instillation Quality-of-life measures after single-access versus conventional laparoscopic cholecystectomy: a prospective randomized study Mini-laparoscopic cholecystectomy vs laparoscopic cholecystectomy Minimizing shoulder pain following laparoscopic cholecystectomy: a prospective, randomized, controlled trial. Intraperitoneal bupivacaine for effective pain relief after laparoscopic cholecystectomy. Randomized comparison between low-pressure laparoscopic cholecystectomy and gasless laparoscopic cholecystectomy Efficacy of a Laparoscopically Delivered Transversus Abdominis Plane Block Technique during Elective Laparoscopic Cholecystectomy: A Prospective, Double-Blind Randomized Trial. 
Two-port versus four-port laparoscopic cholecystectomy
 Single‐incision versus 3‐port laparoscopic cholecystectomy in symptomatic gallstones: A prospective randomized study Randomized Controlled Trial Comparing Single-Port Laparoscopic Cholecystectomy and Four-Port Laparoscopic Cholecystectomy
Context : To assess the analgesic efficacy of the combination of bupivacaine and buprenorphine in alleviating postoperative pain following laparoscopic cholecystectomy . Aims : Laparoscopic cholecystectomy is comparatively advantageous as it offers less pain in the postoperative period and requires a shorter hospital stay . There are only a few studies performed to evaluate the analgesic efficacy of intraperitoneal instillation of buprenorphine and bupivacaine during laparoscopic cholecystectomy . Setting s and Design : The present research is a r and omized , double-blind controlled study conducted in the Department of Anaesthesiology , Dayan and Medical College and Hospital Ludhiana , Punjab after formal ethical approval from Hospital 's Ethics Committee . Subjects and Methods : This study analyzed 90 adults admitted for elective laparoscopic cholecystectomy . After the procedure , subjects were divided into three equal groups to conduct the study . Three Groups A , B , and C had intraperitoneal instillation of the 25 ml of physiological saline ( 0.9 % normal saline ) , 0.25 % of bupivacaine , 0.25 % bupivacaine , and 0.3 mg buprenorphine , respectively . Necessary vitals were monitored and recorded . Visual analog scale ( VAS ) and verbal rating scale ( VRS ) scores were recorded and analyzed systematic ally . Statistical Analysis Used : All observations were analyzed using analysis of variance and Student 's t-test . Results : The mean pain scores were highest in Group A compared to Group B and Group C. Mean VAS and VRS scores were highest in Group C comparatively and lowest in Group A. Conclusion : Combination of buprenorphine and bupivacaine intraperitoneally is comparatively more effective in relieving postoperative pain in comparison to intraperitoneal instillation of bupivacaine alone for postoperative pain management after laparoscopic cholecystectomy Background : Significant pain can be experienced after laparoscopic cholecystectomy . This systematic review aims to formulate PROSPECT ( PROcedure SPECific Postoperative Pain ManagemenT ) recommendations to reduce postoperative pain after laparoscopic cholecystectomy . Methods : R and omised controlled trials published in the English language from January 2006 ( date of last PROSPECT review ) to December 2017 , assessing analgesic , anaesthetic , or operative interventions for laparoscopic cholecystectomy in adults , and reporting pain scores , were retrieved from MEDLINE and Cochrane data bases using PRISMA ( Preferred Reporting Items for Systematic Review s and Meta‐Analyses ) search protocol s. PROSPECT methodology was used , and recommendations were formulated after review and discussion by the PROSPECT group ( an international group of leading pain specialists and surgeons ) . Results : Of 1988 r and omised controlled trials identified , 258 met the inclusion criteria and were included in this review . The studies were of mixed method ological quality , and quantitative analysis was not performed because of heterogeneous study design and how outcomes were reported . Conclusions : We recommend basic analgesic techniques : paracetamol + NSAID or cyclooxygenase‐2 specific inhibitor + surgical site local anaesthetic infiltration . Paracetamol and NSAID should be started before or during operation with dexamethasone ( GRADE A ) . Opioid should be reserved for rescue analgesia only ( GRADE B ) . Gabapentanoids , intraperitoneal local anaesthetic  , and  transversus abdominis plane blocks  are not recommended ( GRADE D ) unless basic analgesia is not possible . Surgically , we recommend low‐pressure pneumoperitoneum , postprocedure saline lavage , and aspiration of pneumoperitoneum ( GRADE A ) . Single‐port incision techniques are not recommended to reduce pain ( GRADE A ) Background Minimizing the number and scope of ports used to perform laparoscopic cholecystectomy attempts to build on the improvements in postoperative pain control , rapid return to activity and work , patient satisfaction , and cosmetic result achieved by the laparoscopic method . Methods We studied 141 patients in two sequential studies : the first a prospect i ve r and omized trial with 41 patients , and the second an examination of the more minimal procedure in 100 patients . In the r and omized trial , patients underwent laparoscopic cholecystectomy with three ports : three 5-mm ports or two 10-mm ports and one 5-mm port .  The 100 patients underwent the three 5-mm port procedure .  Results In the r and omized trial , differences were not statistically significant . However , on the average , the group with three 5-mm ports required less medication over less time , had less postoperative pain , and took less time to return to activity than the second group with larger ports . A statistically significant difference was found in incisional pain between the smaller group ( 21 patients ) with two 10-mm ports and one 5-mm port and the larger group ( 100 patients ) with three 5-mm ports , whether the measure was overall incisional pain ( p=0.014 ) or a comparison based on specific ports ( p=0.001 ) . The percentage of cases requiring port enlargement to remove the gallbladder was not significantly different between the groups . There were no conversions to an open procedure , no fourth trocars added , and no complications . No patient required overnight hospitalization . Conclusions Reducing the number and size of ports in laparoscopic cholecystectomy sustains or enhances the improvements initiated by performing laparoscopic rather than open cholecystectomy . In a comparison of microlaparoscopic procedures , patients undergoing the procedure with the shorter incisions experienced significantly less pain Although laparoscopic cholecystectomy has rapidly become routine practice in the UK , there has been no rigorous comparison of it with open cholecystectomy . In our trial , 302 patients were r and omised to laparoscopic or minilaparotomy cholecystectomy .  Recovery after surgery was assessed by length of hospital stay , outpatient review at 10 days and 4 weeks , and patient question naires 1 , 4 , and 12 weeks after surgery . The mean operation time was 14 min shorter for minilaparotomy , while median post-operative hospital stay was 2 days shorter after laparoscopic cholecystectomy . The hospital costs were about 400 pounds greater for the laparoscopic procedure . Laparoscopic patients returned to work in the home sooner ; at 1 week , they had better physical and social functioning , were less limited by physical problems , and had less pain and depression . At 4 weeks , only physical functioning and depression scores were better in the laparoscopic group , and by 3 months there were no differences . Laparoscopic patients were more satisfied with the appearance of their scars . The incidence of complications after both procedures was 20 % . Compared to minilaparotomy cholecystectomy , laparoscopic cholecystectomy results in shorter hospital stay , less postoperative dysfunction , and quicker return to normal activities , but is more costly Abstract Background R and omized studies could not demonstrate significant outcome benefit after single-incision laparoscopic cholecystectomy compared to classic four-port laparoscopic cholecystectomy ( CLC ) . The new robotic single-site platform might offer potential benefits on local inflammation and postoperative pain due to its technological advantages . This prospect i ve r and omized double-blind trial compared the short-term outcomes between single-incision robotic cholecystectomy ( SIRC ) and CLC . Methods Two groups of 30 eligible patients were r and omized for SIRC or CLC .  During the first postoperative week , patients and study monitors were blinded to the type of procedure performed by four dressing tapes applied on the abdomen . Pain was assessed at 6 h and on day 1 , 7 and 30 after surgery , along with a 1–10 cosmetic score . Results No significant difference in postoperative pain occurred in the two groups at any time point nor for any of the abdominal sites . Nineteen ( 63 % ) SIRC patients reported early postoperative pain in extra-umbilical sites . Intraoperative complications which might influence postoperative pain , such as minor bleeding and bile spillage , were similar in both groups and no conversions occurred . The cosmetic score 1 month postoperatively was higher for SIRC ( p < 0.001 ) . Two SIRC patients had wound infection , one of which developed an incisional hernia . Conclusions SIRC does not offer any significant reduction of postoperative pain compared to CLC . SIRC patients unaware of their type of operation still report pain in extra-umbilical sites like after CLC . The cosmetic advantage of SIRC should be balanced against an increased risk of incisional hernias and higher costs . Trial registration numberACTRN12614000119695 ( http://www.anzctr.org.au ) Laparoscopic cholecystectomy has rapidly become established as the treatment of choice for cholecystolithiasis . There is very little evidence , however , to support the cl aim ed benefit to patients . In the present study 30 consecutive patients below the age of 65 years without acute cholecystitis and with no signs of common bile duct stones were r and omized to laparoscopic or conventional open eholecystectomy .  Median ( interquartile range ) intravenous consumption of pethidine with a patientcontrolled injection device between 13 and 24 h after surgery was 125 ( 62–175 ) mg in patients who underwent the laparoscopic procedure and 200 ( 150–250 ) mg in those who had open operation . Urinary adrenaline and cortisol levels as well as those of plasma glucose , C‐reactive protein and interleukin 6 were increased after surgery in both groups of patients , but without any significant difference between them . The mean(s.d . ) duration of postoperative hospital stay ( 2·8(0·8 ) versus 1·8(0·6 ) days ) and sick leave ( 24·0(4·4 ) versus 11·7(4·1 ) days ) was significantly longer with open than laparoscopic cholecystectomy . The findings demonstrate obvious advantages of laparoscopic surgery  as regards postoperative pain and convalescence , although factors reflecting the magnitude of trauma did not differ Inappropriate therapy of postoperative pain in laparoscopic cholecystectomy may lead to late mobilization , patient dissatisfaction , delayed hospital discharge , and chronic pain development . Our objective was to identify the best therapeutic strategy available to the anesthesiologist for the acute postoperative pain of patients su bmi tted to elective laparoscopic cholecystectomy . This is a systematic review that included 36 complete articles indexed in the Medline , Scopus , Web of Science and LILACS data bases , with a five-year time cut ( 2012 to 2016 ) , result ing from controlled and r and omized studies that were su bmi tted to qualitative analysis . In a proposal for multimodal analgesia , it is important to consider the contraindications , adverse effects , dose and optimal timing of interventions . Non-opioid drugs , such as non-steroidal anti-inflammatory drugs (NSAIDs)/cyclooxygenase-2 ( COX-2 ) inhibitors , gabapentin/pregabalin , N-methyl-D-aspartate ( NMDA ) receptor antagonists , and others . Opioids may be used at low doses associated with multimodal therapy or are restricted to cases where non-opioid multimodal analgesia is insufficient . We conclude that there is no consensus as to the best analgesic strategy to be implemented in the acute postoperative pain of laparoscopic cholecystectomy , which requires its applicability in an individualized way , based on the scientific evidence found in the literature . As contribution to medical learning and practice , we point out the theoretical enrichment of the analgesic drug options available for the therapy of postoperative pain in patients su bmi tted to elective laparoscopic cholecystectomy , and alert the team to consider the adverse effects of the interventions implemented BACKGROUND Laparoscopic cholecystectomy ( LC ) is the gold-st and ard for the treatment of gallbladder stone disease . In recent years laparoendoscopic single site surgery ( LESS ) has gained greater interest and diffusion for the treatment of gallstones and also in bariatric and colonic surgery . However , no r and omized controlled trials are present in the literature that confirm the clinical advantages of LESS compared with the classic laparoscopic procedures . For this reason , we present the preliminary results of this r and omized prospect i ve study regarding the feasibility and safety of LESS cholecystectomy versus classic laparoscopic technique . METHODS Between October 2009 and April 2010 , 50 patients were r and omly assigned to three-port classic laparoscopic cholecystectomy ( n = 25 ) or LESS procedure ( n = 25 ) . Exclusion criteria were : ( 1 ) previous abdominal surgery , ( 2 ) signs of acute cholecystitis , choledocholithiasis , or acute pancreatitis , ( 3 ) ASA grade III or more , ( 4 ) lack of written informed consent , and ( 5 ) BMI ≥ 30 Kg/m(2).All the patients ' details were recorded : age , weight , height , body mass index , operative time , length of hospital stay , patients ' pain and wound satisfaction score . Abdominal pain was registered at 6 , 12 , and 24 h postoperatively . Wound satisfaction score ( very unsatisfied = 1 , unsatisfied = 2 , acceptable = 3 , satisfied = 4 , very satisfied = 5 ) was registered for each patient at the seventh postoperative day . RESULTS No differences were registered between the two groups about gender , age , weight , height , and BMI . Also postoperative hospital stay was similar ( P = 0.71 ) . In three patients ( 1 in group A and 2 in group B ) a 5-mm trocar was added . Intraoperative cholangiography was performed in five patients ( 2 in group A and 3 in group B ) . Mean operative time was significantly longer in LESS procedures ( 41.3 ± 12.0 versus 35.6 ± 5.8 ; P = 0.04 ) . Abdominal postoperative pain was similar in LC and LESS cholecystectomy . Wound satisfaction score showed statistically significant differences between the two groups : in LESS group , patients were more satisfied with the presence of a small umbilical medication ( P < 0.05 ) . CONCLUSION In this r and omized prospect i ve study , we conclude that LESS cholecystectomy is an excellent alternative to traditional three-port cholecystectomy for patients with uncomplicated disease , and no previous abdominal surgery . Although no differences are present about hospital stay and postoperative pain compared with classic laparoscopic cholecystectomy , in our experience LESS has had a significant impact on patients ' wound satisfaction Aim : This study aim ed to investigate the advantages and disadvantages of LP ( 7 mmHg ) in comparison to SP ( 12 mm Hg ) pneumoperitoneum in a prospect i ve r and omized clinical trial . Material s and Methods : 148 consecutive patients qualified for laparoscopic cholecystectomy ( LC ) due to uncomplicated symptomatic gallstones were r and omized to either SPLC or LPLC .  All the procedures were performed by the same experienced team of surgeons . The statistical analysis included sex , mean age , body mass index , ASA grade , operative time , complication rate , conversion rate , postoperative pain assessed by the Visual Analogue Scale of Pain ( VAS ) including the incidence of shoulder-tip pain , postoperative hospital stay , recovery time , and the quality of life ( QOL ) within 7 days following the operation . p < 0.05 was considered as indicative of significance . Results : Neither conversion to an open procedure nor major complications occurred in either group . The operative time was similar in both groups ( LP 55.7 ± 8.6 min vs SP 51.9 ± 8.3 min ) . The mean postoperative pain score was 6.18 ± 3.48 lower after LP than SPLC and the difference amounted to 22.2 % ( p < 0.005 ) . The incidence of shoulder-tip pain was 2.1 times lower after LP than SPLC ( p < 0.05 ) . QOL within 7 days following the operation was remarkably better after LPLC than after SPLC ( p < 0.01 ) . Conclusions : LP pneumoperitoneum is superior to SP pneumoperitoneum in terms of lower postoperative pain , a lower incidence of shoulder-tip pain , and a better QOL within 5 days following the operation . LP should be used for LC in cases of uncomplicated symptomatic gallstones as a recommended procedure as long as an adequate exposure is obtained with this technique Inpatient low-pressure pneumoperitoneum laparoscopic cholecystectomy ( LPLC ) has been shown to have less postoperative pain ( especially shoulder-tip pain ) . No report so far has documented the use of lower-pressure pneumoperitoneum in outpatient laparoscopic cholecystectomy ( LC ) .  A prospect i ve r and omized trial was conducted in Tung Wah Hospital , Day Surgery Centre from January 2004 to December 2004 . A total of 40 patients were recruited and 20 of whom were allocated to each arm . Outcome measures included operation time , treatment-related morbidity , mortality , postoperative pain ( eg , shoulder-tip pain ) , consumption of analgesics , and level of satisfaction . All patients in both groups could be discharged on the same day . Patients ' demographics and operation time were comparable in both groups . There were no treatment-related morbidity and mortality , nor was there any significant difference in postoperative pain . Less shoulder-tip pain was observed in the LPLC group though without significant difference ( 5 % vs. 20 % ; P=0.151 ) . Three patients in the LPLC group needed higher insufflation pressure ( 12 mm Hg ) because of inadequate exposure and adhesions , and the operations were successful in all of them . Otherwise , no conversion to open procedure was noted in both groups . The consumption of analgesics was minimal and a high level of satisfaction was achieved in both groups of patients . The present study demonstrated no difference in LPLC and st and ard-pressure pneumoperitoneum laparoscopic cholecystectomy in the outcomes of outpatient LC . Routine use of lower-pressure pneumoperitoneum in outpatient LC would not be recommended unless in selected straightforward cases Background The attempt to further reduce operative trauma in laparoscopic cholecystectomy has led to new techniques such as natural orifice transluminal endoscopic surgery ( NOTES ) and single-incision laparoscopic surgery ( SILS ) . These new techniques are considered to be painless procedures , but no published studies investigate the possibility of different pain scores in these new techniques versus classic laparoscopic cholecystectomy . In this r and omized control study , we investigated pain scores in SILS cholecystectomy versus classic laparoscopic cholecystectomy . Patients and methods Forty patients ( 34 women and 6 men ) were r and omly assigned to two groups . In group A ( n = 20 ) four-port classic laparoscopic cholecystectomy was performed . Patients in group B ( n = 20 ) underwent SILS cholecystectomy .  In all patients , preincisional local infiltration of ropivacaine around the trocar wounds was performed . Infusion of ropivacaine solution in the right subdiaphragmatic area at the beginning of the procedure plus normal saline infusion in the same area at the end of the procedure was performed in all patients as well . Shoulder tip and abdominal pain were registered at 2 , 6 , 12 , 24 , 48 , and 72 h postoperatively using visual analog scale ( VAS ) . Results Significantly lower pain scores were observed in the SILS group versus the classic laparoscopic cholecystectomy group after the first 12 h for abdominal pain , and after the first 6 h for shoulder pain . Total pain after the first 24 h was nonexistent in the SILS group . Also , requests for analgesics were significantly less in the SILS group , while no difference was observed in incidence of nausea and vomiting between the two groups . ConclusionS ILS cholecystectomy , as well as the invisible scar , has significantly lower abdominal and shoulder pain scores , especially after the first 24 h postoperatively , when this pain is nonexistent . ( Registration Clinical Trial number : NTC00872287 , www . clinical trials.gov ) Objective To investigate to what effect active subdiaphragmatic gas aspiration reduces pain after a laparoscopic cholecystectomy . Material s and Methods A total of 104 patients undergoing laparoscopic cholecystectomy were r and omly placed into 2 groups . Group I included active subdiaphragmatic gas aspiration ( n=52 ) while group II included simple evacuation ( n=52 ) without any additional procedures . Postoperative analgesic requirements were recorded and the level of postoperative abdominal and shoulder pain was assessed using a numeric scale after 24 postoperative hours . Data were analyzed using the & khgr;2 test for nonparametric data and Student t test for parametric data . Results Age , volume of CO2 used during surgery , and operation duration were similar in the 2 groups . The simple evacuation group ( group II ) experienced more shoulder and abdominal pain postoperatively when compared with the active subdiaphragmatic aspiration group ( group I ) and had a higher use of analgesics during the postoperative period . Conclusions Active subdiaphragmatic gas aspiration after a laparoscopic cholecystectomy is a simple procedure that can effectively reduce postoperative abdominal and shoulder pain and as a result the need for analgesics Laparoscopy using carbon dioxide insufflation induces adverse effects in both the cardiovascular and the respiratory function . The use of low pressure pneumoperitoneum has been shown to reduce adverse hemodynamic effects . However , its effect on tissue trauma and postoperative pain and recovery remains controversial . The aim of this study was to compare tissue trauma , postoperative pain , and recovery in two groups of patients undergoing laparoscopic cholecystectomy , one at insufflation pressure of 8 ( LC8 ) and the other at 15 mm Hg ( LC15 ) . Forty patients were r and omized , 20 in each group . The characteristics of the patients were similar in the two groups . The procedure was completed in all patients in the LC15 group , but in 2 patients in the LC8 group the pressure was increased to 15 mm Hg to complete the operation . There were no significant differences in postoperative pain scores , analgesic consumption , and the incidence of nausea , vomiting , and shoulder pain between the two groups . C-reactive protein concentrations and white blood cell count rose significantly after surgery , but the increase was similar in the two groups . The median duration of surgery was similar , 23 minutes ( range 15–65 ) in the LC8 group and 25 minutes ( range 15–80 ) in the LC15 group . Using our technique of laparoscopic cholecystectomy , there were no advantages to tissue damage , postoperative pain , and recovery when a low pressure pneumoperitoneum was used BACKGROUND : Studies evaluating intraperitoneal local anesthetic instillation for pain relief after laparoscopic procedures have reported conflicting results . In this r and omized , double-blind study we assessed the effects of intraperitoneal local anesthetic nebulization on  pain relief  after laparoscopic cholecystectomy . METHODS : Patients undergoing elective laparoscopic cholecystectomy were r and omly assigned to receive either instillation of ropivacaine 0.5 % , 20 mL after induction of the pneumoperitoneum , or nebulization of ropivacaine 1 % , 3 mL before and after surgery . Anesthetic and surgical techniques were st and ardized . Degree of pain at rest and on deep breathing , incidence of shoulder pain , morphine consumption , unassisted walking time , and postoperative nausea and vomiting were evaluated at 6 , 24 , and 48 hours after surgery . RESULTS : Of the 60 patients included , 3 exclusions occurred for conversion to open surgery . There were no differences between groups in pain scores or in morphine consumption . No patients in the nebulization group presented significant shoulder pain in comparison with 83 % of patients in the instillation group ( absolute risk reduction −83 , 95 % CI −97 to −70 , P < 0.001 ) . Nineteen ( 70 % ) patients receiving nebulization walked without assistance within 12 hours after surgery in comparison with 14 ( 47 % ) patients receiving instillation ( absolute risk reduction −24 , 95 % CI −48 to 1 , P = 0.04 ) . One ( 3 % ) patient in the instillation group vomited in comparison with 6 ( 22 % ) patients in the nebulization group ( absolute risk reduction −19 % , 95 % CI −36 to −2 , P = 0.03 ) . CONCLUSIONS : Intraperitoneal ropivacaine nebulization was associated with reduced shoulder pain and unassisted walking time but with an increased incidence of postoperative vomiting after laparoscopic cholecystectomy Background This study aim ed to compare the short-term outcomes of single-access laparoscopic cholecystectomy ( SALC ) and conventional laparoscopic cholecystectomy ( CLC ) . Methods In a prospect i ve study , patients with symptomatic cholelithiasis were r and omized to SALC or CLC with follow-up at 1 week , 1 and 6 months . The primary end point of this study was to assess the total outcomes of quality of life using the EuroQoL EQ-5D question naire . The secondary end points were postoperative pain , analgesia requirement and duration of use , operative time , perioperative complications , estimated blood loss , hospital stay , cosmesis outcome , and number of days required to return to normal activities . Results A total of 269 patients were prospect ively r and omized into two groups ( 125 in each group after excluding 19 patients for various reasons ) . The SALC procedure was done safely without intraoperative or major postoperative complications . In four SALC patients , an extra epigastric port was inserted to enhance exposure . There was no open conversion in either group . SALC patients reported better results among four of the EuroQoL EQ-5D dimensions ( mobility , self-care , activity , and pain/discomfort ) at 1 week after surgery , an improved pain profile at 4 , 12 , and 24 h , better cosmetic outcome at 1 and 6 months ( P ≤ 0.01 ) , shorter duration of need for analgesia ( P ≤ 0.02 ) , and earlier return to normal activities ( P ≤ 0.026 ) . Operative times , hospital stay , QOL at 1 and 6 months postoperatively , and estimated blood loss were similar for both procedures . Conclusion This study supports other studies that show that SALC is a feasible and promising alternative to traditional laparoscopic cholecystectomy in selected patients with better cosmesis , QOL , and improved postoperative pain results , and it can be performed with the existing laparoscopic instruments Background : We set out to assess the safety and efficacy of mini-laparoscopic cholecystectomy ( MLC ) in uncomplicated situations . Methods : MLC was performed on 30 consecutive selected patients ( < 60 years old , ASA I-II , uncomplicated cholecystectomy ) with one 12-mm and three 3-mm ports . The total operating time , conversion rate , degree of postoperative pain , duration of postoperative hospital stay , complications , and cosmetic results were all review ed and compared with 30 cases of consecutive conventional laparoscopic cholecystectomy ( LC ) . Results : None of the patients in either group required conversion to open cholecystectomy . No complications were observed . The operating time and duration of hospital stay were similar in both groups . The level of postoperative pain was lower in the MLC group ( p < 0.001 ) . More patients in the MLC group expressed satisfaction with the cosmetic result ( p < 0.05 ) . Conclusions : MLC was shown to be feasible in uncomplicated situations . Furthermore , it was associated with less pain and produced better cosmetic results than conventional LC . R and omized studies are still needed to confirm these findings UNLABELLED Abstract Background : Postoperative abdominal and shoulder pains after laparoscopic cholecystectomy ( LC ) are the most frequent complaints and are related to delayed recovery . There is a strong correlation between the residual gas volume and the severity of pain following various laparoscopic procedures . We aim ed to investigate the effects of aspiration of residual gas on postoperative outcomes and pain following LC . SUBJECTS AND METHODS Patients were r and omly assigned to either the active gas reduction group ( Group 1 , n=105 ) or the control group ( Group 2 , n=95 ) . After completion of the operative procedures , residual gas was aspirated with a flexible cannula in Group 1 . In Group 2 , gas release from the abdomen was performed using the port site by opening the gas tap only . The demographic data , operation time , insufflated CO2 volume during the operation , hospitalization period , and time to return to daily activities were recorded . Postoperative shoulder and abdominal pain assessment was performed using a numerical pain intensity scale ( NPIS ) at 1 hour , 24 hours , 3 days , and 7 days postoperatively . RESULTS There was no statistically significant difference between the groups in terms of demographic data , operative findings , and clinical outcomes . NPIS scores for shoulder pain at 1 hour and 24 hours were significantly lower in Group 1 ( P=.001 and P=.021 , respectively ) . However , there were no significant differences in the NPIS scores for shoulder and abdominal pain following 24 hours . No differences were found in the hospitalization duration and time to return to daily activities data ( P>.05 ) . CONCLUSIONS Active aspiration of the residual gas just before the removal of the trochars is a simple procedure and leads to a more comfortable hospital stay for patients Laparoscopic cholecystectomy is now widely practised . There are various methods of pain relief used but none has been assessed or compared following this procedure . We have assessed the analgesic effect of intraperitoneal bupivacaine in laparoscopic cholecystectomy . Sixty consecutive patients were r and omly assigned to one of two groups . Patients in group 1 were given 20 ml of saline injected under vision into the region of the gallbladder bed . Patients in group 2 were given 20 ml of 0.25 % bupivacaine in a similar fashion . Postoperative pain was assessed with a visual analogue pain scale and the site of pain was recorded . Patients in the bupivacaine group had less pain in the early postoperative period and a lower incidence of pain in the right hypochondrium . Intraperitoneal bupivacaine is a simple and effective treatment for postoperative pain after laparoscopic cholecystectomy Abstract Background : Laparoscopic cholecystectomy using low-pressure pneumoperitoneum ( 8 mmHg ) minimizes adverse hemodynamic effects , reduces postoperative pain , and accelerates recovery . Similar cl aims are made for gasless laparoscopy using abdominal wall lifting . The aim of this study was to compare gasless laparoscopic cholecystectomy to low-pressure cholecystectomy with respect to postoperative pain and recovery . Methods : Thirty-six patients were r and omized to low-pressure or gasless laparoscopic cholecystectomy using a subcutaneous lifting system ( Laparotenser ) .  Results : The characteristics of the patients were similar in the two groups . The procedure was completed in all patients in the low-pressure group , but two patients in the gasless group were converted to pneumoperitoneum . There were no significant differences in postoperative pain and analgesic consumption , but patients in the gasless group developed shoulder pain more frequently ( 50 % vs 11 % , p < 0.05 ) . Gasless operation took longer to perform ( 95 vs 72.5 min , p= 0.01 ) . Conclusions : Gasless and low-pressure laparoscopic cholecystectomy were similar with respect to postoperative pain and recovery . The gasless technique provided inferior exposure and the operation took longer , but the technique may still have value in high-risk patients with cardiorespiratory disease BACKGROUND The management of postoperative pain is paramount to facilitate the delivery of day case surgical programs . In recent years , the complexity of procedures carried out has increased to include laparoscopic cholecystectomy . The aim of this study was to evaluate the impact of laparoscopic-assisted 4-quadrant transversus abdominis plane ( TAP ) block vs periportal local anesthetic wound infiltration in managing postoperative pain . STUDY DESIGN A prospect i ve , r and omized , double-blinded trial was conducted with patients undergoing elective laparoscopic cholecystectomy . Patients were r and omized using computerized " r and om number table " into a test group that received laparoscopic-assisted TAP block with bupivacaine with periportal saline injection and a control group that received a laparoscopic-assisted TAP block with saline and periportal bupivacaine .  All patients received intraperitoneal instillation of bupivacaine in the gallbladder bed . Postoperative pain scores were recorded using numerical rating scores at rest and coughing at dedicated time points . Statistical analysis was carried out using GraphPad Prism software , version 5 ( GraphPad Software ) and p < 0.05 was considered significant . RESULTS Eighty patients ( 70 female and 10 male ) were enrolled ; 40 patients were r and omized to each group .  Age , American Society of Anesthesiologists score , operative time , and BMI were comparable between the groups . No adverse events were encountered with the administration of TAP blocks . Numerical rating scores were significantly reduced in the test group at 1 , 3 , and 6 hours at rest ( p = 0.025 , p = 0.03 , and p = 0.007 , respectively ) . Numerical rating score was significantly reduced at 1 , 3 , and 6 hours during coughing ( p = 0.026 , p = 0.02 , and p = 0.03 , respectively ) . Difference in postoperative analgesic requirements between both groups was statistically insignificant ( p = 0.17 ) . CONCLUSIONS This analysis has confirmed the therapeutic benefit of laparoscopically delivered TAP blocks in elective laparoscopic cholecystectomy Background : Two-port laparoscopic cholecystectomy has been reported to be safe and feasible . However , whether it offers any additional advantages remains controversial . This study reports a r and omized trial that compared the clinical outcomes of two-port laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy . Methods : One hundred and twenty consecutive patients who underwent elective laparoscopic cholecystectomy were r and omized to receive either the two-port or the four-port technique . All patients were blinded to the type of operation they underwent . Four surgical tapes were applied to st and ard four-port sites in both groups at the end of the operation . All dressings were kept intact until the first follow-up 1 week after surgery . Postoperative pain at the four sites was assessed on the first day after surgery using a 10-cm unscaled visual analog scale ( VAS ) . Other outcome measures included analgesia requirements , length and difficulty of the operation , postoperative stay , and patient satisfaction score on surgery and scars . Results : Demographic data were comparable for both groups . Patients in the two-port group had shorter mean operative time ( 54.6 ± 24.7 min vs 66.9 ± 33.1 min for the four-post group ; p = 0.03 ) and less pain at individual subcostal port sites [ mean score using 10-cm unscaled VAS : 1.5 vs 2.8 ( p = 0.01 ) at the midsubcostal port site and 1.3 vs 2.3 ( p = 0.02 ) at the lateral subcostal port site ] . Overall pain score , analgesia requirements , hospital stay , and patient satisfaction score on surgery and scars were similar between the two groups . Conclusion : Two-port laparoscopic cholecystectomy result ed in less individual port-site pain and similar clinical outcomes but fewer surgical scars compared to four-port laparoscopic cholecystectomy . Thus , it can be recommended as a routine procedure in elective laparoscopic cholecystectomy Background . Laparoscopic cholecystectomy is the st and ard treatment for symptomatic gallbladder disease .  Single‐incision laparoscopic surgery was developed with the aim of decreasing the invasiveness of conventional laparoscopy . The aim of this study was to compare the clinical outcome of single‐incision laparoscopic cholecystectomy with 3‐port laparoscopic cholecystectomy . Methods . From February 2014 to September 2016 , 187 patients with symptomatic cholecystolithiasis were r and omized to a single‐incision laparoscopic cholecystectomy group ( 89 patients ) or a 3‐port laparoscopic cholecystectomy group ( 98 patients ) . The primary outcomes were a postoperative pain score ( at 6 hours and 1 day ) and patients of complications , while the secondary outcomes were operative time , estimated blood loss , opioid requirements , duration of hospital stay , and patient satisfaction with aesthetic effects . Results . When comparing 3‐port laparoscopic cholecystectomy and single‐incision laparoscopic cholecystectomy , there were differences in the ( mean ± st and ard deviation ) operative time ( 58.9 ± 18.6 minutes vs 45.2 ± 11.8 minutes ; P < .001 ) , success rate ( 93 % vs 99 % ; P < .01 ) , conversion rate ( 7 % vs 1 % ; P < .001 ) , and aesthetic score ( 7.9 ± 1.6 vs 6.7 ± 1.4 ; P = .008 ) . There were no statistically significant differences in estimated blood loss , postoperative pain , opioid requirement , complications , and hospital stay between both groups . Conclusion . Single‐incision laparoscopic cholecystectomy is a safe and feasible procedure in selected patients . The main advantage is the superior aesthetic results , while the main disadvantage is a greater operative time with some technical difficulties Objective : To compare short-term surgical outcomes and quality of life ( QOL ) between single-port laparoscopic cholecystectomy ( SPLC ) and classic 4-port laparoscopic cholecystectomy ( CLC ) . Background : There is significant interest in further reducing the trauma associated with surgical procedures . Although a number of observational studies have suggested that SPLC is a feasible alternative to CLC , there is a lack of data from r and omized studies validating any benefit over CLC . Methods : Eligible patients were r and omized to receive SPLC or CLC .  Operative and perioperative outcomes , including cosmesis and QOL were analyzed . Results : Forty-three patients were r and omized to SPLC ( n = 21 ) or CLC ( n = 22 ) . There were no significant differences between groups for most preoperative demographics , American Society of Anesthesiology score , gallstone characteristics , local inflammation , blood loss , or length of stay .  Patients undergoing SPLC were older than those receiving CLC  ( 57.3 years vs. 45.8 years , P < 0.05 ) . Operative times for SPLC were greater than CLC ( 88.5 minutes vs. 44.8 minutes , P < 0.05 ) . Overall and cosmetic satisfaction , QOL as determined by the SF-36 survey , postoperative complications , and post-operative pain scores between discharge and 2-week postoperative visit were not significantly different between groups . Wound infection rates were similar in both groups . The SPLC group contained 1 retained bile duct stone , 1-port site hernia , and 1 postoperative port site hemorrhage . Conclusions : SPLC procedure time was longer and incurred more complications than CLC without significant benefits in patient satisfaction , postoperative pain and QOL .  SPLC may be offered in carefully selected patients . Larger r and omized trials performed later in the learning curve with SPLC may identify more subtle advantages of one method over another
This approach has been design ed to provide adequate analgesia while minimizing exposure to adverse events
Background : Laparoscopic cholecystectomy has advantages over the open procedure for postoperative pain .
However , a systematic review of postoperative pain management in this procedure has not been conducted .