Laparoscopic Surgery May Be Associated With Severe Pain and High Analgesia Requirements in the Immediate Postoperative Period

Ekstein, Perla; Szold, Amir; Sagie, Boaz; Werbin, Nahum; Klausner, Joseph M.; Weinbroum, Avi A.

doi:10.1097/01.sla.0000193806.81428.6f

Cited by 124 publications

(94 citation statements)

References 16 publications

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“…An increase in sympathetic tone may occur due to the sustained pressure from the pneumo-peritoneum on retroperitoneal and para-aortal nerve tissue, splanchnic bed, abdominal and retroperitoneal viscera [10]. Similarly, the CO 2 absorbed from the peritoneal cavity may cause sympathico-excitation [12].…”

Section: Discussionmentioning

confidence: 99%

“…We choose to compare LPS and LPT abdominal surgeries for the reason that there are data that show the presence of differential stressful stimuli between the two procedures [10,11]. For example, during the first postoperative hours laparoscopic surgery is associated with more severe pain and increased analgesic requirements compared to patients after a laparotomy [10]; and during surgery LPS abdominal surgery is associated with enhanced metabolic and stress hormonal responses compared to open surgery [11]. In the current study we use the pulse transit time as a marker of sympathetic tone and a possible surrogate marker of the nociceptive state of the patient and consequently expect significant differences in PTT values between the two surgical techniques.…”

Section: Introductionmentioning

confidence: 99%

“…Next we *Address correspondence to this author at the Department of Anesthesiology, Leiden University Medical Center, P5-Q, 2300 RC Leiden, The Netherlands; Fax: +31 71 526 24 48; E-mail: a.dahan@lumc.nl compared PTT values during surgery in the laparoscopic (LPS) and laparotomic (LPT) groups. We choose to compare LPS and LPT abdominal surgeries for the reason that there are data that show the presence of differential stressful stimuli between the two procedures [10,11]. For example, during the first postoperative hours laparoscopic surgery is associated with more severe pain and increased analgesic requirements compared to patients after a laparotomy [10]; and during surgery LPS abdominal surgery is associated with enhanced metabolic and stress hormonal responses compared to open surgery [11].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Pulse Transit Time (PTT) Measurements During Laparoscopic and Open Abdominal Surgery: A Pilot Study in ASA I-II Female Patients

Sigtermans¹,

Looijestijn²,

Olofsen³

et al. 2008

TOATJ

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Abstract:Background: The pulse transit time (PTT) is the time interval between the R-wave of the ECG and the appearance of the pulse wave in the periphery during the same cardiac cycle. PTT is influenced by various factors including sympathetic tone and vascular compliance. The authors assessed the effect of anesthesia, intubation and laparoscopic (LPS) versus laparotomic (LPT) surgery on PTT.Methods: PTT, mean arterial blood pressure (MAP) and heart rate (HR) were measured during induction of anesthesia and during the first 45-min of LPS (n = 17) and LPT (n = 13) surgery in a group of female patients.Results: Anesthesia increased PTT values, while painful stimuli caused an immediate reduction. During surgery, we observed group effects on PTT and MAP with 10-25% lower PTT values (P < 0.001) and 15-30% greater MAP values (P < 0.01) in the LPS group. HR did not differ between groups. Conclusions:The pulse transit time was used successfully to track the effect of anesthesia and stressful nociceptive stimuli during induction of anesthesia. The shorter PTT values during laparoscopic abdominal surgery compared to open abdominal surgery suggest a higher sympathetic tone in patients undergoing laparoscopic surgery and/or an effect of the increased abdominal pressure on PTT.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pulse Transit Time (PTT) Measurements During Laparoscopic and Open Abdominal Surgery: A Pilot Study in ASA I-II Female Patients

Sigtermans¹,

Looijestijn²,

Olofsen³

et al. 2008

TOATJ

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“…Pain after surgery has been reported to be a consistent problem, which has spanned several decades (Marks & Sachar 1973, Seers 1987, Svensson et al 2000, Wu et al 2002. Nearly half (n = 67) of 145 patients admitted to a postanaesthesia care unit experienced severe pain within a 30-min postoperative period (Ekstein et al 2006). The reasons for this are well documented and include patient barriers, inadequate knowledge of health care professionals, lack of assessment and organisational practices which frequently impede the administration of analgesics and non-pharmacological interventions.…”

Section: Introductionmentioning

confidence: 99%

Barriers to Effective Pain Management

Carr

2007

Journal of Perioperative Practice

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Key Messagesr Patients often have poor understanding regarding pain management, which results in low expectations of pain relief and satisfaction with inadequate pain control.r The experience of pain has long been accepted as an inevitable part of surgical intervention, but new understanding reveals a dynamic and complex nervous system which can change in response to unrelieved pain, potentially leaving permanent damage and chronic pain.r Health care professionals often lack appropriate knowledge, attitudes and skills to effectively manage pain due to inadequate education.r Local hospital regulations and policies may inadvertently inhibit the effective management of pain by causing unnecessary delays to the timely administration of analgesics.r Globally, many people are denied good pain relief due to some countries' inability to effectively import and distribute morphine for medical reasons.

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“…Surprisingly, a recent study observed that laparoscopic surgery is associated with higher pain scores in the first hours postoperatively [16]. Others described higher nociceptive pain scores during laparoscopic procedures compared to conventional open surgery [17].…”

Section: Introductionmentioning

confidence: 98%

Nociceptive and stress hormonal state during abdominal, laparoscopic, and vaginal hysterectomy as predictors of postoperative pain perception

et al. 2012

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The primary objective of this study is to compare pain perception during and after surgery between abdominal hysterectomy (AH), laparoscopic hysterectomy (LH), and vaginal hysterectomy (VH). The secondary objective of this study is to investigate whether pain indicators during surgery predict pain perception and demand for analgesics postoperatively. Prospective observational analysis of intraoperative nociceptive state (by means of pulse transit time; PTT), heart rate, and stress hormone levels (adrenalin and noradrenalin) were correlated with postoperative pain scores and stress hormone levels and demand for postoperative analgesics such as morphine. Intraoperative PTT levels and perioperative and postoperative stress hormone levels did not differ significantly between AH, LH, and VH. During the first hours postoperatively, LH patients showed insignificant lower pain scores, compared to AH and VH. One day postoperatively, LH patients reported significantly lower pain scores. High intraoperative stress hormone levels predicted a significant higher demand for morphine postoperatively, accompanied with significant higher pain scores. No differences were found with respect to intraoperative pain indicators well as pain perception during the first hours after surgery between AH, LH, and VH. If VH is not applicable, LH proves to be advantageous over AH with respect to a faster decline in pain scores.

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Laparoscopic Surgery May Be Associated With Severe Pain and High Analgesia Requirements in the Immediate Postoperative Period

Cited by 124 publications

References 16 publications

Pulse Transit Time (PTT) Measurements During Laparoscopic and Open Abdominal Surgery: A Pilot Study in ASA I-II Female Patients

Pulse Transit Time (PTT) Measurements During Laparoscopic and Open Abdominal Surgery: A Pilot Study in ASA I-II Female Patients

Barriers to Effective Pain Management

Nociceptive and stress hormonal state during abdominal, laparoscopic, and vaginal hysterectomy as predictors of postoperative pain perception

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