Skip to main content
Log in

Effect of drainage on postoperative nausea, vomiting, and pain after laparoscopic cholecystectomy

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Background

Laparoscopic cholecystectomy is associated with a high incidence of postoperative pain, nausea, and vomiting. Pneumoperitoneum created during the operation and residual gas after the operation are two of the factors in postoperative pain and nausea. We studied the effects of a subdiaphragmatic gas drain, which is intended to decrease the residual gas, on postoperative pain, nausea, and vomiting after laparoscopic cholecystectomy.

Patients and methods

Seventy patients were randomized into two demographically and clinically comparable groups: drainage and control. Postoperative pain, nausea, and vomiting were measured by verbal grading and visual analog scale 2–72 h postoperatively. Analgesic and antiemetic use and incidence of retching, vomiting and other complaints were also recorded.

Results

Subdiaphragmatic drain effectively reduced the incidence and amount of subdiaphragmatic gas bubble. The incidence and severity of nausea was lower in the drainage group at 72 h. Although severity of pain was lower at 8 and 12 h in the drainage group, the difference was not significant. There was also no difference between the groups in regard to analgesic and antiemetic use.

Conclusions

Subdiaphragmatic drain offers only minor, if any, benefit on postoperative pain, nausea, and vomiting after laparoscopic cholecystectomy, and this effect is probably clinically irrelevant.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1.
Fig. 2.

Similar content being viewed by others

References

  1. Watcha MF, White PF (1992) Postoperative nausea and vomiting. Its etiology, treatment and prevention. Anesthesiology 77:162–184

    CAS  PubMed  Google Scholar 

  2. Hardacre JM, Talamini MA (2000) Pulmonary and hemodynamic changes during laparoscopy—are they important? Surgery 17:241–244

    Article  Google Scholar 

  3. Fredman B, Jedeikin R, Olsfanger D, Flor P, Gruzman A (1994) Residual pneumoperitoneum: a cause of postoperative pain after laparoscopic cholecystectomy. Anesth Analg 79:152–154

    CAS  PubMed  Google Scholar 

  4. Cunniffe MG, McAnena OJ, Dar MA, Calleary J, Flynn N (1998) A prospective randomized trial of intraoperative bupivacaine irrigation for management of shoulder-tip pain following laparoscopy. Am J Surg 176:258–261

    Article  CAS  PubMed  Google Scholar 

  5. Liberman MA, Howe S, Lane M (2000) Ondansetron versus placebo for prophylaxis of nausea and vomiting in patients undergoing ambulatory laparoscopic cholecystectomy. Am J Surg 179:60–62

    Article  CAS  PubMed  Google Scholar 

  6. Wills VL, Hunt DR (2000) Pain after laparoscopic cholecystectomy. Br J Surg 87:273–284

    Article  CAS  PubMed  Google Scholar 

  7. Sharma RR, Axelsson H, Oberg A, Jansson E, Clergue F, Johansson G, Reiz S (1999) Diaphragmatic activity after laparoscopic cholecystectomy. Anesthesiology 91:406–413

    CAS  PubMed  Google Scholar 

  8. Windberger UB, Auer R, Keplinger F, Langle F, Heinze G, Schindl M, Losert UM (1999) The role of intra-abdominal pressure on splanchnic and pulmonary hemodynamic and metabolic changes during carbon dioxide pneumoperitoneum. Gastrointest Endosc 49:84–91

    CAS  PubMed  Google Scholar 

  9. Sinclair DR, Chung F, Mezei G (1999) Can postoperative nausea and vomiting be predicted? Anesthesiology 91:109–118

    CAS  PubMed  Google Scholar 

  10. Koivuslao AM, Kellokumpu I, Lindgren L (1996) Gasless laparoscopic cholecystectomy: comparison of postoperative recovery with conventional technique. Br J Anaesth 77:576–580

    PubMed  Google Scholar 

  11. Goldberg JM, Maurer WG (1997) A randomized comparison of gasless laparoscopy and CO2 pneumoperitoneum. Obstet Gynecol 90:416–420

    Article  CAS  PubMed  Google Scholar 

  12. Bisgaard T, Klarskov B, Kristiansen VB, Callasen T, Schulze S, Kehlet H, Rosenberg J (1999) Multi-regional local anesthetic infiltration during laparoscopic cholecystectomy in patients receiving prophylactic multi-modal analgesia: a randomized, double-blinded placebo-controlled study. Anesth Analg 89:1017–1024

    CAS  PubMed  Google Scholar 

  13. Wallace DH, Serpell MG, Baxter JN, O'Dwyer PJ (1997) Randomized trial of different insufflation pressures for laparoscopic cholecystectomy. Br J Surg 84:455–458

    CAS  PubMed  Google Scholar 

  14. Alexander JI, Hull MGR (1987) Abdominal pain after laparoscopy: the value of a gas drain. Br J Obstet Gynaecol 94:267–269

    CAS  PubMed  Google Scholar 

  15. Draper K, Jefson R, Jongeward R Jr, Mcleod M (1997) Duration of postlaparoscopic pneumoperitoneum. Surg Endosc 11:809–811

    Article  CAS  PubMed  Google Scholar 

  16. Jorgensen JO, Gillies RB, Hunt DR, Caplehorn JR, Lumley T (1995) A simple and effective way to reduce postoperative pain after laparoscopic cholecystectomy. Aust N Z J Surg 65:466–469

    CAS  PubMed  Google Scholar 

  17. Chamberlain G (1984) The recovery of gases insufflated at laparoscopy. Br J Obstet Gynaecol 91:367–370

    CAS  PubMed  Google Scholar 

  18. Tsimoyiannis EC, Siakas P, Tassis A, Lekkas ET, Tzourou H, Kambili M (1998) Intraperitoneal normal saline infusion for postoperative pain after laparoscopic cholecystectomy. World J Surg 22:824–828

    Article  CAS  PubMed  Google Scholar 

  19. Wills VL, Hunt DR (2000) Pain after laparoscopic cholecystectomy. Br J Surg 87:273–284

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Tarık Zafer Nursal.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nursal, T.Z., Yildirim, S., Tarim, A. et al. Effect of drainage on postoperative nausea, vomiting, and pain after laparoscopic cholecystectomy. Langenbecks Arch Surg 388, 95–100 (2003). https://doi.org/10.1007/s00423-003-0374-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-003-0374-6

Keywords

Navigation