The impact of patient-controlled analgesia on laparoscopic cholecystectomy.
BACKGROUND
Laparoscopic cholecystectomy has revolutionised the management of symptomatic gallstones and is increasingly performed as a day-case procedure. The aim of this study was to assess the impact of opioid patient-controlled analgesia (PCA) on elective laparoscopic cholecystectomy.


METHODS
In a prospective, non-randomised, observational study, 76 consecutive patients who underwent elective in-patient laparoscopic cholecystectomy were reviewed. Six patients with complicated gall stone disease and four patients who converted from laparoscopic to an open operation were excluded.


RESULTS
Of the 66 remaining in the study group, 25 patients received morphine-PCA and, of these, 9 were fit for discharge. In contrast, 41 patients did not receive PCA and, of these, 27 were fit for discharge (P < 0.05). Median Aldrete score in the PCA group was 16 and in the non-PCA group 18 (P < 0.05). Postoperative nausea and vomiting were more common in patients receiving a morphine-based PCA and with in those with higher anti-emetic requirement (10/25 in PCA and 7/41 non-PCA groups; P < 0.05).


CONCLUSIONS
Routine postoperative opioid PCA prolongs the recovery and in-patient stay following elective laparoscopic cholecystectomy. Its role in postoperative pain management in routine laparoscopic cholecystectomy should be questioned.
Sinha
S
S
Department of General Surgery, Torbay Hospital, Torquay, UK. sinhasurajit@hotmail.com
Munikrishnan
V
V
Montgomery
J
J
Mitchell
S J
SJ
D000556:Ambulatory Surgical Procedures; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005260:Female; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D041781:Jaundice, Obstructive / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D009020:Morphine