Glisson’s capsule cauterisation is associated with increased postoperative pain after laparoscopic cholecystectomy: a prospective case–control study

Abstract

INTRODUCTION Postoperative pain after laparoscopic cholecystectomy has three components: parietal, visceral and referred pain felt at the shoulder. Visceral peritoneal injury on the liver (Glisson's capsule) during cauterisation sometimes occurs as an unavoidable complication of the operation. Its effect on postoperative pain has not been quantified. In this study, we aimed to evaluate the association between Glisson's capsule injury and postoperative pain following laparoscopic cholecystectomy. METHODS The study was a prospective case-control of planned standard laparoscopic cholecystectomy with standardized anaesthesia protocol in patients with benign gallbladder disease. Visual analogue scale (VAS) abdominal pain scores were noted at 2 and 24 hours after the operation. One surgical team performed the operations. Operative videos were recorded and examined later by another team to detect presence of Glisson's capsule cauterisation. Eighty-one patients were enrolled into the study. After examination of the operative videos, 46 patients with visceral peritoneal injury were included in the study group, and the remaining 35 formed the control group. RESULTS VAS pain score at postoperative 2 and 24 hours was significantly higher in the study group than control (P = 0.027 and 0.017, respectively). CONCLUSIONS Glisson's capsule cauterisation in laparoscopic cholecystectomy is associated with increased postoperative pain. Additional efforts are recommended to prevent unintentional cauterisation.

Intravenous lidocaine infusion for pain control after laparoscopic cholecystectomy

“…[ 3 ] However, LC was reported to be associated with postoperative pain from moderate-to-intense degrees which delayed postoperative recovery and discharge from the day-surgery unit, leading to unanticipated hospital admission. [ 4 ]…”

Overlay of a sponge soaked with ropivacaine and multisite infiltration analgesia result in faster recovery after laparoscopic hepatectomy

“…Postoperative pain mainly comes from wounds of the abdominal muscle and peritoneum. Beyond those causes, injury of Glisson’s capsule can also influence pain[13,14]. Therefore, in our study, ropivacaine not only infiltrated the subcutaneous and deep muscle fasciae and peritoneum but also covered the liver cutting surface in a soaked gelatin sponge to relieve the pain caused by capsule injury.…”

Effects of perioperative intravenous lidocaine infusion for postoperative pain and recovery in elderly patients undergoing surgery: a systematic review and meta-analysis of randomized controlled trials

“…Postoperative pain management is a major focus after surgery, especially in the field of fast-track surgery, which aims to prevent or reduce common complications including postoperative pain,postoperative nausea and vomiting hypercoagulation deep venous thrombosis, ileus and postoperative cognitive dysfunction and speed up early recovery, in elderly patients [1][2][3][4] .The number of major operations of all over the world annually approaches 250 million [5] with no less than 33 percent of surgical patients over 65 year [6,7] and evidence reveals that postoperative pain and ileus causing extended length of hospital stay are the primary hospitalization expenses driver in the postoperative period [8,9] .Postoperative pain control after surgery in elderly patients has been become a serious clinical problem that many strategies have been applied to decrease postoperative pain and length of hospital stay, containing steroidal anti-inflammation drugs, non-steroidal antiinflammatory drug (NSAID) opioid drugs, patient controlled analgesia (PCA) and local anesthesia [10][11][12] . Nevertheless none of them has indicated identical efficacy and opioid medications can caused side effects including nausea and vomiting, megrim, constipation and delay of postoperative early recovery.…”