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

the PROSPECT collaboration

Research output: Contribution to journalReview article

13 Citations (Scopus)

Abstract

Background: Significant pain can be experienced after laparoscopic cholecystectomy. This systematic review aims to formulate PROSPECT (PROcedure SPECific Postoperative Pain ManagemenT) recommendations to reduce postoperative pain after laparoscopic cholecystectomy. Methods: Randomised controlled trials published in the English language from January 2006 (date of last PROSPECT review) to December 2017, assessing analgesic, anaesthetic, or operative interventions for laparoscopic cholecystectomy in adults, and reporting pain scores, were retrieved from MEDLINE and Cochrane databases using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) search protocols. PROSPECT methodology was used, and recommendations were formulated after review and discussion by the PROSPECT group (an international group of leading pain specialists and surgeons). Results: Of 1988 randomised controlled trials identified, 258 met the inclusion criteria and were included in this review. The studies were of mixed methodological quality, and quantitative analysis was not performed because of heterogeneous study design and how outcomes were reported. Conclusions: We recommend basic analgesic techniques: paracetamol + NSAID or cyclooxygenase-2 specific inhibitor + surgical site local anaesthetic infiltration. Paracetamol and NSAID should be started before or during operation with dexamethasone (GRADE A). Opioid should be reserved for rescue analgesia only (GRADE B). Gabapentanoids, intraperitoneal local anaesthetic, and transversus abdominis plane blocks are not recommended (GRADE D) unless basic analgesia is not possible. Surgically, we recommend low-pressure pneumoperitoneum, postprocedure saline lavage, and aspiration of pneumoperitoneum (GRADE A). Single-port incision techniques are not recommended to reduce pain (GRADE A).

Original languageEnglish (US)
Pages (from-to)787-803
Number of pages17
JournalBritish Journal of Anaesthesia
Volume121
Issue number4
DOIs
StatePublished - Oct 1 2018

Fingerprint

Laparoscopic Cholecystectomy
Pain Management
Pain
Pneumoperitoneum
Non-Steroidal Anti-Inflammatory Agents
Acetaminophen
Postoperative Pain
Local Anesthetics
Analgesia
Analgesics
Randomized Controlled Trials
Abdominal Muscles
Cyclooxygenase 2 Inhibitors
Therapeutic Irrigation
MEDLINE
Dexamethasone
Opioid Analgesics
Anesthetics
Meta-Analysis
Language

Keywords

  • analgesia
  • cholecystectomy
  • multimodal analgesia
  • opioids
  • pain, postoperative

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Evidence-based management of pain after laparoscopic cholecystectomy : a PROSPECT review update. / the PROSPECT collaboration.

In: British Journal of Anaesthesia, Vol. 121, No. 4, 01.10.2018, p. 787-803.

Research output: Contribution to journalReview article

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abstract = "Background: Significant pain can be experienced after laparoscopic cholecystectomy. This systematic review aims to formulate PROSPECT (PROcedure SPECific Postoperative Pain ManagemenT) recommendations to reduce postoperative pain after laparoscopic cholecystectomy. Methods: Randomised controlled trials published in the English language from January 2006 (date of last PROSPECT review) to December 2017, assessing analgesic, anaesthetic, or operative interventions for laparoscopic cholecystectomy in adults, and reporting pain scores, were retrieved from MEDLINE and Cochrane databases using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) search protocols. PROSPECT methodology was used, and recommendations were formulated after review and discussion by the PROSPECT group (an international group of leading pain specialists and surgeons). Results: Of 1988 randomised controlled trials identified, 258 met the inclusion criteria and were included in this review. The studies were of mixed methodological quality, and quantitative analysis was not performed because of heterogeneous study design and how outcomes were reported. Conclusions: We recommend basic analgesic techniques: paracetamol + NSAID or cyclooxygenase-2 specific inhibitor + surgical site local anaesthetic infiltration. Paracetamol and NSAID should be started before or during operation with dexamethasone (GRADE A). Opioid should be reserved for rescue analgesia only (GRADE B). Gabapentanoids, intraperitoneal local anaesthetic, and transversus abdominis plane blocks are not recommended (GRADE D) unless basic analgesia is not possible. Surgically, we recommend low-pressure pneumoperitoneum, postprocedure saline lavage, and aspiration of pneumoperitoneum (GRADE A). Single-port incision techniques are not recommended to reduce pain (GRADE A).",
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AU - Rahiri, J. L.

AU - Tutone, S.

AU - Hill, A. G.

AU - Joshi, G. P.

AU - Kehlet, H.

AU - Schug, S.

AU - Van de Velde, M.

AU - Vercauteren, M.

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AU - Bonnet, F.

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KW - opioids

KW - pain, postoperative

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