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A procedure-specific systematic review and consensus recommendations for postoperative analgesia following laparoscopic cholecystectomy

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Abstract

Background:

Laparoscopic cholecystectomy has advantages over the open procedure for postoperative pain. However, a systematic review of postoperative pain management in this procedure has not been conducted.

Methods:

A systematic review was conducted according to the guidelines of the Cochrane Collaboration. Randomized studies examining the effect of medical or surgical interventions on linear pain scores in patients undergoing laparoscopic cholecystectomy were included. Qualitative and quantitative analyses were performed. Recommendations for patient care were derived from review of these data, evidence from other relevant procedures, and clinical practice observations collated by the Delphi method among the authors.

Results:

Sixty-nine randomized trials were included and 77 reports were excluded. Recommendations are provided for preoperative analgesia, anesthetic and operative techniques, and intraoperative and postoperative analgesia.

Conclusions:

A step-up approach to the management of postoperative pain following laparoscopic cholecystectomy is recommended. This approach has been designed to provide adequate analgesia while minimizing exposure to adverse events.

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Acknowledgment

The PROSPECT Working Group is supported by an unrestricted educational grant from Pfizer Inc., New York, USA.

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Authors and Affiliations

  1. Section for Surgical Pathophysiology, 4074, The Juliane Marie Centre , Rigshospitalet, Denmark

    H. Kehlet

  2. Medical Department, Choice Medical Communications, Hitchin, England

    A. W. Gray

  3. Service Anesthesie Reanimation, Hôpital Tenon, Paris, France

    F. Bonnet

  4. Department of Anesthesiology, Flemish Free University of Brussels Medical Center, Brussels, Belgium

    F. Camu

  5. Department of Anaesthesiology, Alexandra Hospital, Redditch, Worcestershire, England

    H. B. J. Fischer

  6. University Department of Surgery, Manchester Royal Infirmary, Manchester, England

    R. F. McCloy

  7. Biochemical and Experimental Division, Medical Faculty, University of Cologne, Germany

    E. A. M. Neugebauer

  8. Department of Anaesthesiology, Hospital Universitario del Mar, Universidad Autonoma of Barcelona, Spain

    M. M. Puig

  9. Department of Anaesthesia and Intensive Care, University Hospital, Örebro, Sweden

    N. Rawal

  10. Department of Orthopaedic Surgery, Merheim Hospital, University of Witten-Herdecke, Germany

    C. J. P. Simanski

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Correspondence to H. Kehlet.

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This material was presented in part as abstracts at the Euroanaesthesia Congress in Glasgow, Scotland, 2003

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Kehlet, H., Gray, A.W., Bonnet, F. et al. A procedure-specific systematic review and consensus recommendations for postoperative analgesia following laparoscopic cholecystectomy. Surg Endosc 19, 1396–1415 (2005). https://doi.org/10.1007/s00464-004-2173-8

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