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 .
Preoperative Multimodal Analgesia Facilitates Recovery After Ambulatory Laparoscopic Cholecystectomy
Laparoscopy approach to cholecystectomy has shortened the recovery period , reducing discharge times from 1 to 3 days to same-day discharge . We hypothesize that the use of more than one modality to prevent postoperative pain may be more efficacious than single modality . Patients were r and omized to a treatment ( n = 24 ) or control ( n = 25 ) group and studied using a prospect i ve , double-blind design . Preoperatively , at 45 min before induction of anesthesia , the treatment group received an intramuscular ( IM ) bolus injection of meperidine 0.6 mg/kg and ketorolac 0.5 mg/kg . The control group received two bolus IM injections of placebo ( normal saline ) . Ten minutes before incision , local anesthesia ( treatment group ) or saline ( control group ) was infiltrated into the skin of each patient . Anesthetic management , postoperative pain , and nausea treatment were st and ardized . Pain and nausea assessment were done 1 h preoperatively , 0 , 0.5 , 1 , 2 , 3 , and 4 h postoperatively , at discharge , and 10 , 24 , and 48 h postoperatively . Patients were discharged by scoring criteria . Postoperatively , significantly more patients in the treatment group were without pain on arrival in the postanesthesia care unit ( PACU ) , 12/21 ( 57.1 % ) vs 1/24 ( 4.2 % ) in the control group ( P < 0.001 ) . Similarly , the severity of pain was sixfold less in the treatment group than in the control group . The incidence of nausea in the PACU was significantly less in the treatment group ; 4.7 % vs 29.5 % in the control group ( P < 0.05 ) . Patients from the treatment group satisfied Postanesthesia Discharge Score significantly earlier than those in the control group ( 281 + /- 12 min vs 375 + /- 19 min ; P < 005 ) . The concomitant use of local anesthetic and nonsteroidal antiinflammatory and opioid drugs proved to be highly effective in our patients , result ing in faster recovery and discharge . ( Anesth Analg 1996;82:44 - 51
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 .