Postoperative Pain
Surgical trauma contributes to pain and pulmonary dysfunction.
Laparoscopy allows a significant reduction in postoperative pain and analgesic consumption
[3]
[163]
[175]
[177]
[178]
[179]
[180]
[181]
[182]
(see Chapter 72
). Nevertheless,
pain intensity may be significant.[183]
[184]
[185]
The nature of pain varies depending on the
surgical technique; after laparotomy, patients complain more of parietal pain (e.g.,
abdominal wall), whereas after laparoscopic cholecystectomy, patients report also
visceral pain (e.g., biliary colic [cholecystectomy], pelvic spasm [tubal ligation]),
and shoulder-tip pain resulting from diaphragmatic irritation.[3]
[184]
[185]
CO2
insufflation induces more discomfort than use of N2
O as the insufflating
gas.[186]
Pain after laparoscopy is multifactorial, and different treatments
have been proposed to provide pain relief.[187]
[188]
Local anesthetic infiltration (e.g., intraperitoneal,
port-site infiltration) for postoperative pain relief after laparoscopic cholecystectomy
produces contradictory results.[189]
[190]
[191]
[192]
[193]
Benefits of intraperitoneal local anesthetic are greater after gynecologic laparoscopy.
[189]
[194]
Mesosalpinx
block decreases postoperative pain and analgesic consumption after laparoscopic sterilization.
[189]
Residual CO2
pneumoperitoneum
contributes
to postoperative pain, and careful evacuation of residual CO2
after desufflation
was shown to be effective.[195]
[196]
[197]
Preoperative administration of nonsteroidal
anti-inflammatory drugs (NSAIDs) decreases pain, as does opiate consumption after
gynecologic laparoscopy[198]
[199]
[200]
[201]
and
laparoscopic
cholecystectomy.[202]
[203]
However, others have failed to demonstrate any significant effect of preoperative
NSAIDs on pain after laparoscopic sterilization more severe than after diagnostic
gynecologic laparoscopy.[204]
[205]
[206]
[207]
Multimodal
analgesia is also effective in reducing postoperative pain.[208]
[209]
[210]
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