A randomized, prospective, blinded comparison of postoperative pain, metabolic response, and perceived health after laparoscopic and small incision cholecystectomy

Squirrell, David; Majeed, Ali W.; Troy, G; Peacock, J. E.; Nicholl, Jon; Johnson, A. G.

doi:10.1067/msy.1998.87552

Cited by 98 publications

(68 citation statements)

References 20 publications

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“…The granulocyte count and IL-6 level were lower in patients undergoing laparoscopic surgery (16,17,20), and the immunocompetence measured by phytohemagglutinin responsiveness was also stronger for the laparoscopic group (17). Laparoscopic surgery is associated with a significant decrease in monocyte and neutrophil release of O 2 Ϫ , TNF-␣, chemotaxis, and white blood cell count (29). However, CD4/ CD8 ratios were still decreased after laparoscopic surgery but reverted back to normal 1 week later (15).…”

Section: Discussionmentioning

confidence: 94%

Clarithromycin Attenuates Mastectomy-Induced Acute Inflammatory Response

Chow¹,

Yuen

Woo

et al. 2000

Clin Diagn Lab Immunol

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Based on the observation that administration of clarithromycin led to an attenuation of the inflammatory response induced by surgical trauma in a guinea pig model, we investigated the potential beneficial effects of clarithromycin on the local and systemic inflammatory response in patients undergoing mastectomy in an open-label prospective study. During a 16-month period, 54 patients who underwent mastectomy were randomly divided into two groups. In one group, the patients received oral clarithromycin at a dose of 500 mg twice a day, from the day before to 3 days after mastectomy. There was no significant difference in the incidence of antibiotic prophylaxis-related toxicities or postoperative infections between the patients who received clarithromycin and those who did not. Clarithromycin treatment was significantly associated with an attenuation of febrile response, tachycardia, tachypnea, and an increase in monocyte counts (P, <0.0001, <0.01, <0.05, and <0.01, respectively). Clarithromycin also reduced the intensity and duration of postoperative pain (P, <0.05 and <0.005, respectively) and increased the range of motion of the involved shoulder (P < 0.05 for abduction and flexion). We conclude that clarithromycin effectively modulates the acute inflammatory response associated with mastectomy and produces a better clinical outcome.Surgical operations induce major physiological and immunological changes. These changes are activated by various stimuli, such as nociceptive stimulation, tissue injury, tissue ischemia, reperfusion, and hemodynamic disturbances. The clinical response is the result of complex changes, which include dysregulation of T-cell function, changes in the balance of cytokines and counterregulatory hormones, and increased hepatic synthesis of acute-phase reactants. In most patients, the systemic changes are minimal and self-limiting. However, in patients with complicated surgery or major trauma, the response becomes extensive and prolonged, resulting in systemic inflammatory response syndrome (SIRS), which is characterized by increased or suppressed body temperature, increased heart rate, hyperventilation, and an abnormal peripheral leukocyte count (2). Although an inflammatory response is an inevitable and essential part of the repair process and a natural defensive reaction to prevent infections associated with trauma, such undesirable fallout from surgical treatment is associated with significant morbidity and even mortality.The macrolide group of antibiotics is associated with in vitro and in vivo immunomodulating activities (18,(31)(32)(33). Erythromycin, one of the macrolides, has been used extensively for antimicrobial prophylaxis in colorectal surgery (22). Recently, it has also been shown that clarithromycin attenuates the inflammatory response induced by surgical trauma in a guinea pig model (32).Mastectomy is a suitable surgical procedure for the study of the acute inflammatory response to surgery because the extensive dissection causes significant tissue damage and bacterial contam...

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Section: Discussionmentioning

confidence: 94%

Clarithromycin Attenuates Mastectomy-Induced Acute Inflammatory Response

Chow¹,

Yuen

Woo

et al. 2000

Clin Diagn Lab Immunol

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“…In contrast, generic measures of patient health have been largely insensitive to changes during surgical recovery. [8][9][10] Such relative equipoise among treatments, as evident in some high profile clinical trials, [8,11,12] may be mistakenly interpreted as a lack of differences in convalescence. As these questionnaires were not designed explicitly for measuring postoperative recovery, they may fail to capture important constructs that ultimately result in considerable ascertainment bias.…”

Section: Introductionmentioning

confidence: 99%

Development and validation of the convalescence and recovery evaluation (CARE) for measuring quality of life after surgery

et al. 2008

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Purpose-To develop a generic instrument for measuring short-term health status in the recovery period among patients undergoing abdominal and pelvic surgery.Methods-Instrument content was based on qualitative data ascertained from focus groups of patients and input from an expert panel of clinicians and psychometricians. A draft questionnaire was then piloted and revised, leading to the 27-item Convalescence And Recovery Evaluation (CARE). CARE consists of 4 individually-scored domains, which were identified using factor analysis. Test-retest reliability, internal consistency, and convergent validity were assessed.Results-Test-retest reliability was high, ranging from 0.78 for the activity domain to > 0.88 for all others. Internal consistency varied over time postoperatively, but was moderate to high for all domains throughout. Correlations between the 4 domains of CARE were low (each r ≤ 0.57). Moderate agreement was evident between CARE domains and the appropriate components of validated instruments, providing convergent validity.Conclusions-CARE is a robust, multi-dimensional measure of convalescence after abdominal and pelvic surgery. CARE can be used to better understand the phenomenon of recovery and to measure the impact of new processes of care (e.g., surgical technology adoption) on short-term patient outcomes.

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“…2 This surgical technique has been a milestone in the management of gall bladder disease by reducing postoperative pain, risk of surgical site infection and incisional hernia. 3 Laparoscopic cholecystectomy is also reported to have an advantage over open cholecystectomy due to shorter hospital stay, early return to work and overall low cost. 4 Pain is the most frequent complaint after laparoscopic cholecystectomy and the main reason for staying overnight at hospital on the day of operation.…”

Section: Introductionmentioning

confidence: 99%

A comparative study of the incidence of pain and infection in gall bladder extraction via umbilical and epigastric port

et al. 2017

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Background: In laparoscopic cholecystectomy, gall bladder extraction via different ports has always been a matter of concern for the surgeons. This study is designed so as to determine the difference in the rate of pain and infection in gall bladder extraction via umbilical and epigastric port.Methods: A prospective randomized study was done from January 2015 to December 2015 at S. N. Medical College, Agra in which 200 patients of cholelithiasis were considered. The patients were randomly selected in the operation theatre for gall bladder extraction via epigastric port (designated as Group-A with n = 100 patients) and gall bladder extraction via umbilical port (designated as Group-B with n = 100 patients).Results: Post-operative pain at 24 hours, in terms of VAS was 3.67±1.42 in Group-A while 2.47±1.17 in Group-B with 10 being the worst pain. The p-value was calculated as .000048. The result is significant at p< .05. A total of eight patients out of two hundred patients suffered port site infections amongst which five were from Group-A (5%) and three were from Group-B (3%).Conclusions: This study thus indicates that in laparoscopic cholecystectomy, gall bladder retrieval through the umbilical port is a better alternative to gall bladder extraction via epigastric port in terms of post-operative pain and port site infection. Our study recommends gall bladder extraction via umbilical port rather than epigastric port.

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A randomized, prospective, blinded comparison of postoperative pain, metabolic response, and perceived health after laparoscopic and small incision cholecystectomy

Cited by 98 publications

References 20 publications

Clarithromycin Attenuates Mastectomy-Induced Acute Inflammatory Response

Clarithromycin Attenuates Mastectomy-Induced Acute Inflammatory Response

Development and validation of the convalescence and recovery evaluation (CARE) for measuring quality of life after surgery

A comparative study of the incidence of pain and infection in gall bladder extraction via umbilical and epigastric port

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