Small-scale studies have suggested a large inter-individual variation in early
postoperative pain after
laparoscopic cholecystectomy, emphasizing the need for improved
analgesic treatment and valid predictors. We investigated prospectively the association between a preoperative nociceptive stimulus by
ice water (cold pressor test), neuroticism,
dyspepsia, patient history of biliary symptoms, intraoperative factors, and demographic information in 150 consecutive patients undergoing uncomplicated
laparoscopic cholecystectomy for their influence on early
postoperative pain. During the first postoperative week patients registered overall
pain, incisional, visceral, and
shoulder pain on a visual analogue scale and verbal rating scale, and daily
analgesic requirements were noted. Throughout the first postoperative week overall
pain showed a pronounced inter-individual variability. Incisional
pain dominated in incidence and intensity compared with
visceral pain, which in turn dominated over
shoulder pain. In a multivariate analysis model, preoperative neuroticism, sensitivity to cold pressor-induced
pain, and age were identified as independent risk factors for early
postoperative pain. Our results suggest that future
analgesic studies after
laparoscopic cholecystectomy should focus on reduction of incisional
pain.