Pain after laparoscopic cholecystectomy

Abstract

It is postulated that laparoscopic cholecystectomy as “patient-friendly surgery” leads to more comfort and in particular to less pain. A prospective study on pain was performed on all patients undergoing the operation over the period of 1 year (n=382) out of a series of more than 1,000 patients who have undergone the operation in our clinic. Pain was measured by a 100-point visual analogue scale (VAS), by a five-point verbal rating scale, and by the consumption of analgesics. Pain was the most frequent symptom, both before and after the operation. The mean level of pain was 37 VAS points 5 h after the operation and declined to 16 points on the third day. In 106 patients (27.8%) the intensity of pain was higher than 50 VAS points. Analgesics were used by 282 patients (73.8%), opioids by 112 (29.3%). Pain was significantly higher in female than male patients (P<0.05), but consumption of analgesics was similar in both groups. The most severe pain was localized to the abdominal wall wounds by 157 (41.1%) and to the right upper abdomen by 138 patients (36.1%) on the first postoperative day. Patients who needed opioids and/or had a pain level of >50 VAS points (n=138) had higher preoperative pain levels (P=0.018) and preoperatively complained more frequently about nausea, vomiting, bloating, and a feeling of abdominal pressure (P=0.003–0.031). However, predictive values of these variables were too small to be of clinical benefit. The duration of operation, intraoperative events (loss of bile, blood, or gallstones), and additional laparoscopic procedures (adhesiolysis, lavage, extension of an incision, suture of fascia) did not influence the intensity of postoperative pain. We conclude that laparoscopic cholecystectomy did cause significant postoperative pain in one-third of our patients only up to the first postoperative day. As predictors for high intensity of pain were not identified, pain should be monitored and analgesics should be delivered liberally.