Laparoscopic surgery: a narrative review of pharmacotherapy in pain management.
Laparoscopic surgery is widespread, and an increasing number of surgeries are performed laparoscopically. Early pain after laparoscopy can be similar or even more severe than that after open surgery. Thus, proactive pain management should be provided. Pain after laparoscopic surgery is derived from multiple origins; therefore, a single agent is seldom sufficient. Pain is most effectively controlled by a multimodal, preventive analgesia approach, such as combining opioids with non-opioid analgesics and local anaesthetics. Wound and port site local anaesthetic injections decrease abdominal wall pain by 1-1.5 units on a 0-10 pain scale. Inflammatory pain and shoulder pain can be controlled by NSAIDs or corticosteroids. In some patient groups, adjuvant drugs, ketamine and α2-adrenergic agonists can be helpful, but evidence on gabapentinoids is conflicting. In the present review, the types of pain that need to be taken into account while planning pain management protocols and the wide range of analgesic options that have been assessed in laparoscopic surgery are critically assessed. Recommendations to the clinician will be made regarding how to manage acute pain and how to prevent persistent postoperative pain. It is important to identify patients at the highest risk for severe and prolonged post-operative pain, and to have a proactive strategy in place for these individuals.
Department of Anaesthesia, Satakunta Central Hospital, Pori, Finland.
Sari
S
Sjövall
Department of Anaesthesia and Operative Services, Kuopio University Hospital, PO Box 100, 700029 KYS, Kuopio, Finland.|Department of Anaesthesiology and Intensive Care, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
Merja
M
Kokki
Department of Anaesthesia and Operative Services, Kuopio University Hospital, PO Box 100, 700029 KYS, Kuopio, Finland. hannu.kokki@uef.fi.|Department of Anaesthesiology and Intensive Care, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland. hannu.kokki@uef.fi.
Hannu
H
Kokki
D000082:Acetaminophen / Q000627:therapeutic use; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D058647:Adrenergic alpha-2 Receptor Agonists / Q000627:therapeutic use; D000588:Amines / Q000627:therapeutic use; D000700:Analgesics / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D000077206:Gabapentin; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D059408:Pain Management / Q000009:adverse effects / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D000069583:Pregabalin / Q000627:therapeutic use; D016194:Receptors, N-Methyl-D-Aspartate / Q000037:antagonists & inhibitors; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D058647:Adrenergic alpha-2 Receptor Agonists; D000588:Amines; D000700:Analgesics; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D003509:Cyclohexanecarboxylic Acids; D016194:Receptors, N-Methyl-D-Aspartate; D000082:Acetaminophen; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin