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 .
Effect of timing of morphine administration during remifentanil-based anaesthesia on early recovery from anaesthesia and postoperative pain.
BACKGROUND Since the time to peak analgesic effect of intravenous morphine can be longer than 40 - 60 min in volunteers , the goal of this study was to evaluate the effect of the timing of intraoperative morphine administration on  early postoperative pain .  METHODS A total of 120 adult patients undergoing laparoscopic cholecystectomy were studied .  Anaesthesia was induced with remifentanil and etomi date and maintained with remifentanil and sevoflurane/nitrous oxide . Morphine 150 micrograms kg-1 was given r and omly at three different times during surgery , and a fourth group received placebo .  Times to eyes opening and extubation were measured , and pain was evaluated in the post-anaesthesia care unit ( PACU ) using a visual analogue scale ( VAS ) . Morphine 2 - 3 mg was given when the VAS score was > or = 50 mm . The four groups were , according to the time elapsed from morphine administration to the end of surgery , group 1 ( n = 30 ) : placebo ; group 2 ( n = 33 ) : < 20 min ; group 3 ( n = 30 ) : 20 - 40 min ; group 4 ( n = 27 ) : > 40 min . RESULTS Recovery from anaesthesia and pain scores were similar in all groups . However , mean ( SD ) morphine consumption was 5.7 ( 4.7 ) mg in group 1 , 4.4 ( 4.2 ) mg in group 2 , 4.7 ( 4.7 ) mg in group 3 , and 2.2 ( 4.0 ) mg in group 4 ( P < 0.05 , group 1 vs 4 ) .  Morphine  was required in only 38 % of patients in group 4 compared with 83 % , 67 % and 69 % in groups 1 , 2 , and 3 , respectively ( P < 0.01 , group 1 vs 4 ) . CONCLUSIONS The timing of intraoperative morphine administration did not affect the early recovery from anaesthesia . However , the reduction in the number of patients requiring morphine  in the PACU when morphine had been given more than 40 min before the end of surgery supports this practice , rather than administration closer to the end of surgery
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 .