Pharmacological Methods of Postoperative Pain Management After Laparoscopic Cholecystectomy: A Review of Meta-analyses

Abstract

Background: Laparoscopic cholecystectomy (LC) is the optimal approach for patients with symptomatic cholecystolithiasis. Although LC has some advantages, many patients experience postoperative pain. Methods: In this review, we aimed to study the available information and meta-analyses of pharmacological methods of postoperative pain management in patients undergoing LC. Two researchers conducted a literature search in multiple databases (PubMed, Web of Science, Science Direct, Scopus, EMBASE, and Cochrane Library). Papers on pharmacological management of postoperative pain for patients undergoing LC were considered eligible. All meta-analyses, with or without a systematic search, were included in our review. The researchers read the study titles and abstracts to identify relevant articles and appraise the full-text manuscripts. Of 145 papers, the full-text of 11 articles, which met the inclusion criteria, was studied. Information, including the authors’ names, publication data, type of review, patients’ characteristics, interventions, outcomes, sample size, pooled effect size, publication bias, and statistical and methodological heterogeneity, was extracted. The collected data were presented descriptively, without further statistical analysis. Results and Conclusions: Very low to low–quality evidence indicated that pharmacological agents, such as nonsteroidal anti-inflammatory drugs, lidocaine, parecoxib, nefopam, dexamethasone, and magnesium sulfate, could decrease pain intensity in patients undergoing LC. Moreover, moderate to high–quality evidence showed that intravenous infusion of ketamine and opioids, as well as pregabalin, was effective in pain control. Further, robust clinical trials are needed with several arms (eg, pharmacological agents) to compare the efficacy and safety of analgesics under similar clinical conditions and to find optimal regimens for pain management in patients undergoing LC.

Comparative Study of Dezocine and Ketorolac Tromethamine in Patient-Controlled Intravenous Analgesia of Laparoscopic Cholecystectomy

“…This will cause a series of strong stress reactions in the body and may lead to fear, anxiety, irritability, and other adverse emotions, as well as respiratory, circulatory, endocrine, and other dysfunction of the body. These circumstances thus increase the disease burden of patients, slow down the recovery speed after surgery, and lower the quality of life ( 2 , 3 ). According to the research report, the incidence of postoperative incision pain in patients who underwent LC is as high as 79.2%, and it mainly occurs within 24 h after surgery, which is not conducive to the physical and mental health of patients ( 4 ).…”

The Effect of Preoperative Oral Melatonin on Postoperative Pain after Lumbar Disc Surgery: A Double-Blinded Randomized Clinical Trial

“…Use of multimodal pain management as an approach to post-operative pain control has been well documented. In addition, the use of narcotics is associated with dose-related complications such as respiratory depression, nausea, vomiting, urinary retention, itching, drowsiness or postoperative ileus ( 9 ). A newer approach has been well established with use of pre-emptive analgesia to reduce postoperative pain and narcotic consumption ( 10 ).…”

Determining a Method to Minimize Pain After Laparoscopic Cholecystectomy Surgery

“…3,4 Although LC causes less postoperative pain compared with conventional surgery, it is still not a completely painless procedure. 5,6 Significant surgery complications are still a serious problem today. Although performing cholecystectomies laparotomically or laparoscopically has no difference in terms of mortality, LC is widely preferred because it shortens the hospital stay and has a much faster recovery time.…”

“…Because of the better postoperative period, LC has become the gold standard surgical method for gallbladder diseases 3,4. Although LC causes less postoperative pain compared with conventional surgery, it is still not a completely painless procedure 5,6. Significant surgery complications are still a serious problem today.…”

“…The severity of the pain that develops in the postoperative period varies depending on the size of the surgical trauma and the anesthetic approach as well as the physiological, psychological, emotional, and sociocultural factors of the patient. Complications that may develop can be reduced by effective control of postsurgical pain 5,6…”