Abstract: The impact of patient-controlled analgesia on laparoscopic cholecystectomy.

Authors:

Sinha S, Munikrishnan V, Montgomery J, Mitchell SJ.

Institution:

Department of General Surgery, Torbay Hospital, Torquay, UK

Source:

Ann R Coll Surg Engl. 2007 May;89(4):374-8.

Abstract:

INTRODUCTION: Laparoscopic cholecystectomy has revolutionised the management of symptomatic gallstones and is increasingly performed as a day-case procedure. The aim of this study was to assess the impact of opioid patient-controlled analgesia (PCA) on elective laparoscopic cholecystectomy. PATIENTS AND METHODS: In a prospective, non-randomised, observational study, 76 consecutive patients who underwent elective in-patient laparoscopic cholecystectomy were reviewed. Six patients with complicated gall stone disease and four patients who converted from laparoscopic to an open operation were excluded. RESULTS: Of the 66 remaining in the study group, 25 patients received morphine-PCA and, of these, 9 were fit for discharge. In contrast, 41 patients did not receive PCA and, of these, 27 were fit for discharge (P < 0.05). Median Aldrete score in the PCA group was 16 and in the non-PCA group 18 (P < 0.05). Postoperative nausea and vomiting were more common in patients receiving a morphine-based PCA and with in those with higher anti-emetic requirement (10/25 in PCA and 7/41 non-PCA groups; P < 0.05). CONCLUSIONS: Routine postoperative opioid PCA prolongs the recovery and in-patient stay following elective laparoscopic cholecystectomy. Its role in postoperative pain management in routine laparoscopic cholecystectomy should be questioned.

Keywords:

General Surgery Laparoscopic Cholecystectomy Analgesia Patient Controlled Complications