Evaluation of a protocol for postoperative pain management in patients with laparoscopic cholecystectomy

Abstract

This is a prospective trial to evaluate the efficiency of a multimodal analgesic protocol for postoperative pain therapy after laparoscopic cholecystectomy.
Two hundred consenting patients undergoing laparoscopic cholecystectomy were randomly divided into two groups:
– the multimodal analgesia group (AS); 100 patients who received 60 mg of ketorolac given intravenously, before the induction of anaesthesia, and 60 ml of bupivacaine 0.25% instilated intraperitonealy at the end of procedure;
– the control group (AM); 100 patients with postoperative analgesia “by request”: ketorolac alone or associated with an opioid (morphine).
The demographic data were similar within the two groups, as well the type of general anaesthesia and the length of the procedure.
Assessment of postoperative pain was made by means of the unidimensionale methods, visual analogue scale (VAS) and verbal scale (VS), the results being statisticaly evaluated. The postoperative outcome was also evaluated and compared in terms of early mobilization, early feeding, length of postoperative ileus, length of PACU stay and hospitalization, the incidence of mortality and morbidity and patients’ satisfaction.
In the AS group the pain scores were constantly under 3, none of the patients having asked for supplemental analgesia. The results were statistically different in the control group (p<0.05): painful scores over 3; the patients asked for supplemental analgesia during the first 48 postoperative hours.
Multimodal analgesia seems to be efficient not only for postoperative pain therapy but it also improves the postoperative outcome. In the AS group, the mobilisation and oral feeding were earlier, and the postoperative ileus was shorter as compared with the control group. There was an earlier ambulation from the PACU, as well as from the hospital, in AS group, and the cost/benefit ratio seems to be better.
Key words: laparoscopic cholecystectomy, multi modal analgesia, ketorolac, bupivacaine, postoperative pain, visual analogue scale, postoperative outcome

Jurnalul Român de Anestezie Terapie intensivă 2003 Vol.10 Nr.2, 93-100

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Evaluarea unui protocol pentru terapia durerii post colecistectomie laparoscopică