Pain after microlaparoscopic cholecystectomy. A randomized double-blind controlled study.

Abstract

BACKGROUND:

Laparoscopic cholecystectomy (LC) is traditionally performed with two 10-mm and two 5-mm trocars. The effect of smaller port incisions on pain has not been established in controlled studies.

METHODS:

In a double-blind controlled study, patients were randomized to LC or cholecystectomy with three 2-mm trocars and one 10-mm trocar (micro-LC). All patients received a multimodal analgesic regimen, including incisional local anesthetics at the beginning of surgery, NSAID, and paracetamol. Pain was registered preoperatively, for the first 3 h postoperatively, and daily for the 1st week.

RESULTS:

The study was discontinued after inclusion of 26 patients because five of the 13 patients (38%) randomized to micro-LC were converted to LC. In the remaining 21 patients, overall pain and incisional pain intensity during the first 3 h postoperatively increased in the LC group (n = 13) compared with preoperative pain levels (p<0.01), whereas pain did not increase in the micro-LC group (n = 8).

CONCLUSIONS:

Micro-LC in combination with a prophylactic multimodal analgesic regimen reduced postoperative pain for the first 3 h postoperatively. However, the micro-LC led to an unacceptable rate of conversion to LC (38%). The micro-LC instruments therefore need further technical development before this surgical technique can be used on a routine basis for laparoscopic cholecystectomy.

• Authors: T Bisgaard, B Klarskov, R Trap, H Kehlet, J Rosenberg
• Journal: Surgical endoscopy (Surg Endosc) Vol. 14 Issue 4 Pg. 340-4 (Apr 2000) ISSN: 1432-2218 [Electronic] Germany
• PMID: 10790551 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Anesthetics

Topics

• Adult
• Aged
• Anesthetics (therapeutic use)
• Cholecystectomy, Laparoscopic (methods)
• Cholelithiasis (surgery)
• Double-Blind Method
• Female
• Humans
• Male
• Microsurgery
• Middle Aged
• Pain Measurement
• Pain, Postoperative (etiology, prevention & control)