Laparoscopic Surgery: A Narrative Review of Pharmacotherapy in Pain Management

Abstract

Laparoscopic surgery is widespread, and an increasing number of surgeries are performed laparoscopically. Early pain after laparoscopy can be similar or even more severe than that after open surgery. Thus, proactive pain management should be provided. Pain after laparoscopic surgery is derived from multiple origins; therefore, a single agent is seldom sufficient. Pain is most effectively controlled by a multimodal, preventive analgesia approach, such as combining opioids with non-opioid analgesics and local anaesthetics. Wound and port site local anaesthetic injections decrease abdominal wall pain by 1-1.5 units on a 0-10 pain scale. Inflammatory pain and shoulder pain can be controlled by NSAIDs or corticosteroids. In some patient groups, adjuvant drugs, ketamine and α2-adrenergic agonists can be helpful, but evidence on gabapentinoids is conflicting. In the present review, the types of pain that need to be taken into account while planning pain management protocols and the wide range of analgesic options that have been assessed in laparoscopic surgery are critically assessed. Recommendations to the clinician will be made regarding how to manage acute pain and how to prevent persistent postoperative pain. It is important to identify patients at the highest risk for severe and prolonged post-operative pain, and to have a proactive strategy in place for these individuals.

Consistency of postoperative pain assessments between nurses and patients undergoing enhanced recovery after gynaecological surgery

“…In our study, all participants underwent laparoscopic surgery, which has been shown to be safe and feasible for treating gynaecological diseases (Prodromidou et al, ). After gynaecological laparoscopy, the main pain areas include incision pain, surgical area pain in the abdominal cavity and other pain in areas such as the shoulder (Sjövall et al, ). We found that the main pain areas after gynaecological laparoscopy from 4 hr after surgery to POD1 and POD2 were surgical area pain in the abdominal cavity and abdominal incision pain (Table ).…”

“…They assessed the pain of 100 laparoscopic cholecystectomy patients during the first postoperative week, and the results indicated abdominal incision pain and surgical area pain in the abdominal cavity were most reported pain areas. Another study reported that the surgical area pain in the abdominal cavity and abdominal incision pain after laparoscopic surgery lasted for 2–6 days (Sjövall et al, ). So it is reasonable that surgical area pain in the abdominal cavity and abdominal incision pain in our study were observed from 4 hr after surgery to POD1 and POD2.…”

“…All participants underwent laparoscopic surgery. The main pain areas of laparoscopic surgery include incision pain, surgical area pain in the abdominal cavity, and other pain in areas such as the shoulders and back (Sjövall, Kokki, & Kokki, ; Kokki et al, ; Donatsky, Bjerrum, & Gögenur, ). We used “A,” “B” and “C” to represent the three pain areas, respectively, and “D” to represent “no pain.” The assessment method regarding the patients involved reporting the pain location by patients, and, regarding the nurses, they assessed the pain location by verbally asking the patients where they felt pain.…”

Patient-Controlled Analgesia (PCA) in Acute Pain: Pharmacological and Clinical Aspects

“…Despite being most frequently used orally, in recent years, its intravenous use has increased. Its potency is about 1/75 of fentanyl, and in some studies has shown great potency up to 1/60 [48,49].…”

Comparison of oxycodone and fentanyl for postoperative patient-controlled analgesia after orthopedic surgery

“…www.anesth-pain-med.org cular, subcutaneous, rectal, and epidural [11][12][13][14][15]. Numerous studies have suggested that IV oxycodone is an effective treatment for acute postoperative pain [16,17].…”