Incidence and Risk Factors of Moderate to Severe Pain in 24 hours after Laparoscopic Cholecystectomy

Abstract

Objective: Laparoscopic cholecystectomy (LC) is considered to cause no significant pain. However, the literature reveals 58%- 87% incidence of moderate to severe post-operative after this procedure. The objectives of this study were 1) finding the incidence of moderate to severe pain during the first 24 hours after LC surgery, and 2) identifying risk factors for it.

Methods: In a retrospective study the charts of 245 patients ≥ 18 years of age with LC surgery at Siriraj Hospital in 2008 were reviewed. Cases with conversion to open cholecystectomy were excluded. Insufficient documentation (pain score recorded < 5 times within the first 24 hours) was also an exclusion criterion. Demographic data and peri-operative anesthetic and surgi- cal characteristics including outcome and pain therapy were recorded.

Results: Two hundred and forty LC cases (67 male, 163 female) with diagnosis of calculus of gall bladder, acute or chronic cholecystitis, and cholangitis met the criteria. The incidence of moderate to severe pain (NRS 4-10) within the first 24 hours was 76.7%. Risk factors of relevant post-operative pain with statistical significance were not identified. However, patients receiving NSAIDs tended to have less pain. In 30 patients with persistent moderate to severe pain up to 48 hours post-operatively, postoperative vomiting and prolonged surgery (> 60 minutes) were significant risk factors.

Conclusion: Within the limitations of a retrospective study, we conclude that in LC surgery giving NSAIDs and antiemetic drugs prophylactically may lead to a better pain control, especially in prolonged surgical cases.