The Simple and Multidimensional Method of Pain Reduction After Laparoscopic Cholecystectomy: A Randomized Prospective Controlled Trial

Background: Herein, we evaluate the effect of pain relief after laparoscopic cholecystectomy (LC) of various intraoperative maneuvers through a prospective randomized study and identify the synergistic effects of combined maneuvers compared with a single maneuver that was shown to be useful in a previous report. Methods: Fifty-one patients who were scheduled for elective LC were randomly allocated to group A (26 patients, on whom were performed the combined maneuver) or group B (25 patients, no maneuvers). In group A, the patient underwent several maneuvers concomitantly during LC: injection of local anesthesia at the incision site, low-pressure pneumoperitoneum, active gas suction (AGS), and pulmonary recruitment. Pain after LC was assessed using the visual analog scale (VAS) and the measurement of analgesic consumption. Results: Four cases of postoperative morbidity relevant to the analgesic supplements developed (one case, 3.8%, in group A, and the others, 12%, in group B, P=.350) The mean analgesic consumption of group A was significantly lower than that of group B (48.1 +/- 46.3 mg versus 106.7 +/- 83.3 mg, P=.000), and VAS was also lower in group A at postoperative 6, 12, and 24 hours (3.7 +/- 1.2 versus 4.8 +/- 1.7, 1.5 +/- 0.6 versus 3.3 +/- 1.3, and 1.0 +/- 0.6 versus 3.0 +/- 1.7, respectively; P=.016, .000, and .000). Group A showed lower VAS than did a group in our previous study given AGS alone. Conclusions: Our combined maneuvers, comprising of various simple methods during LC, could be effective and feasible means of reducing the convoluted pain that occurs after LC, and also reduce the demand for analgesics.