Evidence-based management of pain after laparoscopic cholecystectomy: a PROSPECT review update

Barazanchi, Ahmed; MacFater, Wiremu; Rahiri, Jamie‐Lee; Tutone, Senitila; Hill, Andrew; Joshi, Girish P.; Kehlet, Henrik; Schug, Stephan A.; Velde, M. Van de; Vercauteren, Martine; Lirk, Philipp; Rawal, Narinder; Bonnet, Francis; Lavand’homme, Patricia; Beloeil, Hélène; Ræder, Johan; Pogatzki-Zahn, Esther

doi:10.1016/j.bja.2018.06.023

Cited by 130 publications

(104 citation statements)

References 183 publications

(20 reference statements)

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“…Pain accounts to 4.7% as the reason for unexpected overnight stay in a planned daycase laparoscopic cholecystectomy (5) . At the same time, the recent PROSPECT (PROcedure SPECific Postoperative Pain Management) Working Group 2018 has recommended port site infiltration along with NSAIDS and paracetamol as the preferred mode of analgesia for laparoscopic cholecystectomy (1) .…”

Section: Discussionmentioning

confidence: 99%

“…Our study didn't include the intraperitoneal instillation of local anesthetic and dexmedetomidine which would have benefitted the patients in terms of postoperative analgesia. Recent literature evidence has recommended port site infiltration along with NSAIDS and paracetamol as the preferred mode of analgesia for laparoscopic cholecystectomy (1) .…”

Section: Discussionmentioning

confidence: 99%

“…Laparoscopic cholecystectomy is the mainstay treatment of benign biliary disease. Pain continues to be an important issue after laparoscopic cholecystectomy resulting in prolonged admissions or readmissions (1) . Inadequately controlled pain has undesirable physiologic and psychologic consequences such as increased postoperative morbidity, delayed recovery, a delayed return to normal daily living, and reduced patient satisfaction (2) .…”

Section: Introductionmentioning

confidence: 99%

“…As a significant proportion of surgical pain originates from the surgical wound, it would seem logical to use local anesthetics at the site of surgery to manage perioperative pain. The recent PROSPECT (PROcedure SPECific Postoperative Pain Management) Working Group has recommended port site infiltration along with NSAIDS and paracetamol as the preferred mode of analgesia for laparoscopic cholecystectomy (1) . Recent reviews has shown that dexmedetomidine usage intraoperatively has better postoperative outcomes in terms of improved morbidity and mortality (3) .…”

Section: Introductionmentioning

confidence: 99%

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Effect of dexmedetomidine as an adjuvant to 0.25% bupivacaine for local infiltration of port site in laparoscopic cholecystectomy in terms of quality and duration of post-op analgesia

Selvaraj¹,

Kamaraj²

2019

JARSS

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Objective: Laparoscopic cholecystectomy (LC) technically has evolved as a day case procedure even to a extent that ASA III patients are also not a exclusion. Pain is one of the cause for unexpected overnight hospital stay. The recent PROSPECT (PROcedure SPECific Postoperative Pain Management) working Group has recommended port site infiltration along with NSAIDS and paracetamol as the preferred mode of analgesia for laparoscopic cholecystectomy. Hence, we studied about efficacy of dexmedetomidine as an adjuvant for local anesthetic portsite wound infiltration with bupivacaine in patients undergoing laparoscopic cholecystectomy. Methods: 120 patients of ASA I-II scheduled for LC were randomly allotted to two groups. Group A received port site wound infiltration with 24 mL of 0.25% bupivacaine and dexmedetomidine 2 µg kg -1 while Group B received wound infiltration with 24 mL of 0.25% bupivacaine divided equally for all the four laparoscopic port sites. A standard general anesthesia technique was used in all the patients. Pre-emptive analgesia with paracetamol 1 g IV given 30 minutes before skin incision. Tramadol 1 mg kg -1 and ketorolac 0.5 mg kg -1 IV infusion was administered as rescue analgesic. Postoperative pain score, duration of effective analgesia, need for rescue analgesic, time of ambulation and hospital discharge was recorded. Results: Dexmedetomidine group has better pain score, longer duration of effective analgesia, lower percentage of patients requiring rescue analgesic, and earlier ambulation and hospital discharge. Conclusion: We conclude that dexmedetomidine 2 μg kg -1 is an effective adjuvant to bupivacaine for port site wound infiltration in terms of quality and duration of postoperative analgesia following laparoscopic cholecystectomy. ÖZAmaç: Laparoskopik kolesistektomi (LK), teknik açıdan, ASA III hastaların bile dışlanmadığı günübirlik bir işlem haline gelmiştir. Ağrı, beklenmedik gece hastanede yatış nedenlerinden biridir. PROSPECT (PROcedure SPECific Postoperative Pain Management) çalışma grubu, NSAİİ'lar ve parasetamol ile port sahası infiltrasyonunu laparoskopik kolesistektomi için tercih edilen analjezi şekli olarak önermektedir. Buradan yola çıkarak, laparoskopik kolesistektomi yapılan hastalarda, port sahasına yara yeri infiltrasyonunda bupivakaine adjuvan olarak eklenen deksmedetomidinin etkinliğini çalıştık. Yöntem: LK planlanan 120 ASA I-II hasta rastgele iki gruba ayrıldı. Grup A'ya 24 mL %0.25 bupivakain ve 2 mcg kg -1 deksmedetomidin ile, Grup B'ye 24 mL % 0.25 bupivakain ile yara infiltrasyonu dört laparoskopik port bölgesi için eşit olarak bölünmüş dozda uygulandı. Tüm hastalarda standart bir genel anestezi tekniği kullanıldı. Cilt insizyonundan 30 dk önce parasetamol 1 g iv ile pre-emptif analjezi uygulandı. Tramadol 1 mg kg -1 ve ketorolak 0.5 mg kg -1 iv ile kurtarıcı analjezi sağlandı. Postoperatif ağrı skoru, etkili analjezi süresi, kurtarıcı analjezik ihtiyacı, ile mobilizasyon ve taburculuk zamanları kaydedildi. Bulgular: Deksmedetomidin grubunda, ağrı skoru daha iy...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effect of dexmedetomidine as an adjuvant to 0.25% bupivacaine for local infiltration of port site in laparoscopic cholecystectomy in terms of quality and duration of post-op analgesia

Selvaraj¹,

Kamaraj²

2019

JARSS

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“…Surgical wound and intra-articular injection with local anesthesia has also been demonstrated in some studies to be effective for postoperative analgesia. This was demonstrated in patients undergoing cesarean section [143], knee replacement surgery [144], and laparoscopic cholecystectomy [145]. However, there are reported negative studies in patients undergoing hip arthroscopy [146] and knee replacement surgery [147].…”

Section: Surgical Wound Infiltrationmentioning

confidence: 99%

State of the art opioid-sparing strategies for post-operative pain in adult surgical patients

Gabriel

Swisher

Sztain

et al. 2019

Expert Opinion on Pharmacotherapy

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Introduction: There are various important implications associated with poorly controlled postoperative pain in the adult surgical patientthis includes cardiopulmonary complications, opioid-related side effects, unplanned hospital admissions, prolonged hospital stay, and the subsequent development of chronic pain or opioid addiction. With the ongoing national opioid crisis, it is imperative that perioperative providers implement pathways for surgical patients that reduce opioid requirements and painrelated complications. Areas covered: In this review, the authors discuss the components of a multimodal opioid-sparing analgesia pathway as it pertains to the perioperative environment. Medications reviewed include gabapentinoids, acetaminophen, non-steroidal anti-inflammatory drugs, ketamine, intravenous lidocaine, dexmedetomidine, and glucocorticoids. The use of peripheral nerve blocks and neuraxial analgesia are also discussed. Expert opinion: In appropriate cases, regional anesthetic interventions are extremely useful for postoperative analgesia, including peripheral nerve blocks and neuraxial analgesia and while newer postoperative analgesics have been postulated, the literature on such is presently controversial. Coordinated approaches to pain management are recommended to reduce the need for opioids and to improve patient satisfaction post-surgery.

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Intraperitoneal local anaesthetic instillation versus no intraperitoneal local anaesthetic instillation for laparoscopic cholecystectomy

Rutherford

Massie

Worsley

et al. 2021

Cochrane Database of Systematic Reviews

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Evidence-based management of pain after laparoscopic cholecystectomy: a PROSPECT review update

Cited by 130 publications

References 183 publications

Effect of dexmedetomidine as an adjuvant to 0.25% bupivacaine for local infiltration of port site in laparoscopic cholecystectomy in terms of quality and duration of post-op analgesia

Effect of dexmedetomidine as an adjuvant to 0.25% bupivacaine for local infiltration of port site in laparoscopic cholecystectomy in terms of quality and duration of post-op analgesia

State of the art opioid-sparing strategies for post-operative pain in adult surgical patients

Intraperitoneal local anaesthetic instillation versus no intraperitoneal local anaesthetic instillation for laparoscopic cholecystectomy

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