Post-operative recovery profile after laparoscopic cholecystectomy: a prospective, observational study of a multimodal anaesthetic regime.
BACKGROUND
Laparoscopic cholecystectomy is now often an ambulatory procedure, but dependent on short-term post-operative complaints of pain and post-operative nausea and vomiting (PONV). The efficacy of post-anaesthesia care units (PACUs) is therefore important to facilitate return to normal functions. We investigated the feasibility and efficacy of a standardized, evidence-based anaesthesia/analgesic regime to identify residual problems in the early post-operative phase.


METHODS
One hundred and thirty-four consecutive patients admitted for elective laparoscopic cholecystectomy at Hvidovre University Hospital between 15 March and 30 September 2005 were included in the study. The standardized, evidence-based regime consisted of total intravenous (i.v.) anaesthesia (propofol-remifentanil), well-defined fluid therapy, dexamethasone, ketorolac, ondansetron, sufentanil and incisional bupivacaine intra-operatively, and in the PACU on demand (prn) administration of sufentanil, morphine, paracetamol, ondansetron, droperidol, oral fluids and oxygen (if SpO(2) < 93%) with PACU discharge using a modified Aldrete score.


RESULTS
Protocol violations were moderate and occurred unsystematically, 8% had medical violations and 10% did not receive the pre-planned fluid amount. Severe PONV was seen in 2%. Thirteen per cent experienced severe pain, and the presence of any pain and/or PONV were predictors of an extended PACU stay. Mean oxygen demand was 46 min (range, 0-300 min), which influenced time to discharge (mean, 88 min). There were on average 2.7 treatment interventions (range, 0-11) before discharge.


CONCLUSIONS
An evidence-based, multimodal approach to the anaesthetic/analgesic management in laparoscopic cholecystectomy is feasible and advantageous in the early post-operative phase. Pain and PONV are predictors of a complicated recovery profile and deserve further attention. Transient oxygen desaturations postpone discharge from the PACU, but the clinical significance of this fact is questionable.
Jensen
K
K
Department of Anaesthesiology and Intensive Care, Hvidovre University Hospital, Hvidovre, Denmark. atc@dadlnet.dk
Kehlet
H
H
Lund
C M
CM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000762:Anesthesia Recovery Period; D019162:Anesthetics, Combined / Q000627:therapeutic use*; D002648:Child; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D015331:Cohort Studies; D004334:Drug Administration Schedule; D017558:Elective Surgical Procedures / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000008:administration & dosage; D010147:Pain Measurement / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D019162:Anesthetics, Combined; D010100:Oxygen