Pain after laparoscopy

Abstract

On the basis of the factors implicated in postlaparoscopy pain, the following recommendations can be made in an attempt to reduce such pain: emphathically consider each patients' unique sociocultural and individual pain experience; inject port sites with local anesthesia at the start of the operation; keep intra-abdominal pressure during pneumoperitoneum below 15 mmHg, avoiding pressure peaks and prolonged insufflation; use humidified gas at body temperature if available; use nonsteroidal anti-inflammatory drugs at the time of induction; attempt to evacuate all intraperitoneal gas at the end of the operation; and use drains only when required, rather than as a routine.

Innovative technique for the study of pneumoperitoneum in the evaluation of abdominal pain after chemical irritation with zymozan

“…When laparoscopy was first performed, the maintenance of positive intraabdominal pressure throughout the laparoscopic procedure was considered nonphysiological and associated with adverse metabolic, immunological, hemodynamic and oncological effects 3,4 .…”

“…In an attempt to assess the real analgesic effect of pneumoperitoneum in animal experimentation, this study used a product that provokes peritoneal irritation (zymosan), as proven in cytokine/pain study protocols 3,13,14 .…”

“…Among these advantages, diminished postoperative pain, a reduction in respiratory complications, reduced hospital admittance and an early return to normal activities can be cited 1,2,3 .…”

“…The analgesic effect of pneumoperitoneum is maintained for 3-5 postoperative days, further contributing to better quality of life in these patients 3 .…”

“…The beneficial effects of insufflation have been related to mastocyte degranulation, responsible for the liberation of vasoactive substances (histamine, adrenalin) and cytokines (IL-4 and IL-10), denominated as antiinflammatory, which have been shown to limit the inflammatory response to pain, inhibiting the production of hyperallergic cytokines and prostaglandins 3 .…”