Pain after laparoscopic cholecystectomy.
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.


CONCLUSIONS
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.
Wills
V L
VL
Upper Gastrointestinal Surgical Unit, Level 5, Suite 1, St George Private Medical Centre, South Street, Kogarah, 2217 New South Wales, Australia.
Hunt
D R
DR
D000772:Anesthesia, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D002986:Clinical Trials as Topic; D006801:Humans; D007327:Insufflation; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D012965:Sodium Chloride / Q000008:administration & dosage
D000894:Anti-Inflammatory Agents, Non-Steroidal; D012965:Sodium Chloride