Post-operative recovery profile after laparoscopic cholecystectomy: a prospective, observational study of a multimodal anaesthetic regime.

Abstract

BACKGROUND:

Laparoscopic cholecystectomy is now often an ambulatory procedure, but dependent on short-term post-operative complaints of pain and post-operative nausea and vomiting (PONV). The efficacy of post-anaesthesia care units (PACUs) is therefore important to facilitate return to normal functions. We investigated the feasibility and efficacy of a standardized, evidence-based anaesthesia/analgesic regime to identify residual problems in the early post-operative phase.

METHODS:

One hundred and thirty-four consecutive patients admitted for elective laparoscopic cholecystectomy at Hvidovre University Hospital between 15 March and 30 September 2005 were included in the study. The standardized, evidence-based regime consisted of total intravenous (i.v.) anaesthesia (propofol-remifentanil), well-defined fluid therapy, dexamethasone, ketorolac, ondansetron, sufentanil and incisional bupivacaine intra-operatively, and in the PACU on demand (prn) administration of sufentanil, morphine, paracetamol, ondansetron, droperidol, oral fluids and oxygen (if SpO(2) < 93%) with PACU discharge using a modified Aldrete score.

RESULTS:

Protocol violations were moderate and occurred unsystematically, 8% had medical violations and 10% did not receive the pre-planned fluid amount. Severe PONV was seen in 2%. Thirteen per cent experienced severe pain, and the presence of any pain and/or PONV were predictors of an extended PACU stay. Mean oxygen demand was 46 min (range, 0-300 min), which influenced time to discharge (mean, 88 min). There were on average 2.7 treatment interventions (range, 0-11) before discharge.

CONCLUSION:

An evidence-based, multimodal approach to the anaesthetic/analgesic management in laparoscopic cholecystectomy is feasible and advantageous in the early post-operative phase. Pain and PONV are predictors of a complicated recovery profile and deserve further attention. Transient oxygen desaturations postpone discharge from the PACU, but the clinical significance of this fact is questionable.

• Authors: K Jensen, H Kehlet, C M Lund
• Journal: Acta anaesthesiologica Scandinavica (Acta Anaesthesiol Scand) Vol. 51 Issue 4 Pg. 464-71 (Apr 2007) ISSN: 0001-5172 [Print] England
• PMID: 17378786 (Publication Type: Journal Article)

Chemical References

• Anesthetics, Combined
• Oxygen

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Anesthesia Recovery Period
• Anesthetics, Combined (therapeutic use)
• Child
• Cholecystectomy, Laparoscopic (methods)
• Cohort Studies
• Drug Administration Schedule
• Elective Surgical Procedures (methods)
• Feasibility Studies
• Female
• Humans
• Intraoperative Care (methods)
• Length of Stay
• Male
• Middle Aged
• Oxygen (administration & dosage)
• Pain Measurement (methods)
• Postoperative Complications (epidemiology)
• Prospective Studies
• Risk Factors
• Treatment Outcome