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Abstract
Laparoscopic cholecystectomy is the preferred surgical technique for uncomplicated cholecystectomy, because of an improved postoperative course. Although laparoscopic cholecystectomy, compared with the open procedure, may be associated with diminished surgical trauma and shortened convalescence, early postoperative pain after laparoscopic procedures is a frequent complaint. Furthermore, the fact that laparoscopic cholecystectomy is performed on a day-case or a fast-track basis, emphasizes the importance of improving early postoperative pain.
Pain after laparoscopic cholecystectomy may vary in quality and localization and is reported in several trials to be incisional, intraabdominal, or referred (shoulder tip). The etiology is complex, including damage to abdominal wall structures, the induction of visceral trauma and inflammation, and peritoneal irritation because of CO2 entrapment beneath the hemidiaphragms. However, several studies have shown that visceral pain is the major component.
Acute pain is typically associated with neuroendocrine stress response that is proportional to pain intensity, and it has been hypothesized that a reduction in surgical stress responses (endocrine, metabolic and inflammatory) will lead to a reduced incidence of postoperative organ dysfunction and thereby to an improved outcome. The latter suggests that effective postoperative pain management is not only human but a very important aspect of postoperative care.