Causes and Preventions of Pain after Laparoscopic Cholecystectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 YU Hong(Female) ,  YUHong

Department of The Second General Surgery, Shengjing Hospital of China Medical University, Shenyang 110000, Liaoning Province, China;

Corresponding author：

YUHong, Email: Yuhong1973@163.com

Keywords：

Laparoscopic cholecystectomy; Postoperative pain; Cause; Prevention

DOI：

10.7507/1007-9424.20160294

Video：

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Objective To explore the causes and preventive measures of pain after laparoscopic cholecystectomy (LC). Methods Domestic and international literatures were collected to summary the causes and preventions of pain after LC. Results Pain after LC had several origins:the irritative effect of carbon dioxide (CO₂) gas, residual pockets of CO₂ in the abdominal cavity, peritoneal and diaphragmatic stretching and injury, and complications related to the operation. The main measures included:nitrous oxide (N₂O) gas insufflation or abdominal wall lift, low-pressure of pneumoperitoneum, shortened the time of pneumoperitoneum, active gas aspiration, intra-abdominal instillation of isotonic saline, the use of local anesthesia as well as Traditional Chinese medicine. Conclusions The causes of pain after LC are multifactorial. It is the key to reduce postoperative pain that we should pay more attention to every perioperative aspect.

Citation： YU Hong(Female), YU Hong. Causes and Preventions of Pain after Laparoscopic Cholecystectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(9): 1151-1155. doi: 10.7507/1007-9424.20160294 Copy

1.	Mitra S, Khandelwal P, Roberts K, et al. Pain relief in laparoscopic cholecystectomy-a review of the current options. Pain Pract, 2012, 12(6):485-496.
2.	Donatsky AM, Bjerrum F, Gögenur I. Surgical techniques to minimize shoulder pain after laparoscopic cholecystectomy. A systematic review. Surg Endosc, 2013, 27(7):2275-2282.
3.	韩小云, 戴新娟, 徐静娟, 等.腹腔镜胆囊切除术后并发肩部痛的原因及护理干预研究进展.护理研究, 2012, 26(19):1737-1739.
4.	Yasir M, Mehta KS, Banday VH, et al. Evaluation of post operative shoulder tip pain in low pressure versus standard pressure pneumoperitoneum during laparoscopic cholecystectomy. Surgeon, 2012, 10(2):71-74.
5.	Kandil TS, El Hefnawy E. Shoulder pain following laparoscopic cholecystectomy:factors affecting the incidence and severity. J Laparoendosc Adv Surg Tech A, 2010, 20(8):677-682.
6.	Sandhu T, Yamada S, Ariyakachon V, et al. Low-pressure pneumoperitoneum versus standard pneumoperitoneum in laparoscopic cholecystectomy, a prospective randomized clinical trial. Surg Endosc, 2009, 23(5):1044-1047.
7.	Lee JS, Kim EY, Lee SH, et al. A simple method of reducing residual intraperitoneal carbon dioxide after laparoscopic cholecystectomy:a prospective, randomized, controlled study. J Laparoendosc Adv Surg Tech A, 2014, 24(8):563-566.
8.	Klugsberger B, Schreiner M, Rothe A, et al. Warmed, humidified carbon dioxide insufflation versus standard carbon dioxide in laparoscopic cholecystectomy:a double-blinded randomized controlled trial. Surg Endosc, 2014, 28(9):2656-2660.
9.	李家福, 周家军.腹腔镜胆囊切除术后上腹痛原因分析.腹腔镜外科杂志, 2010, 15(10):775-776.
10.	李晋, 刘进衡.腹腔镜胆囊切除术后疼痛原因分析.中外健康文摘, 2013, 10(28):63-64.
11.	Aitola P, Airo I, Kaukinen S, et al. Comparison of N₂O and CO₂ pneumoperitoneums during laparoscopic cholecystectomy with special reference to postoperative pain. Surg Laparosc Endosc, 1998, 8(2):140-144.
12.	Sharp JR, Pierson WP, Brady CE. Comparison of CO₂and N₂O-induced discomfort during peritoneoscopy under local anesthesia. Gastroenterology, 1982, 82(3):453-456.
13.	王建球, 周海华, 史佩东, 等.免气腹及气腹腹腔镜胆囊切除术的对比研究.肝胆外科杂志, 2014, 22(3):184-187.
14.	郑俊城, 彭毅, 钟立明, 等.空气与二氧化碳气腹腹腔镜胆囊切除术的比较.中国微创外科杂志, 2014, 14(5):389-392.
15.	王黎滨.改良气腹法减轻腹腔镜胆囊切除术后疼痛的效果评估.中国中西医结合急救杂志, 2010, 17(1):57.
16.	Singla S, Mittal G, Mittal RK. Pain management after laparoscopic cholecystectomy-a randomized prospective trial of low pressure and standard pressure pneumoperitoneum. J Clin Diagn Res, 2014, 8(2):92-94.
17.	申海军, 陈广瑜, 詹建兴, 等.腹腔镜胆囊切除术气腹压力、手术时间对肝功能、颈肩痛及恶心呕吐的影响.中国现代医药杂志, 2012, 14(1):58-60.
18.	Sabzi Sarvestani A, Zamiri M. Residual pneumoperitoneum volume and postlaparoscopic cholecystectomy pain. Anesth Pain Med, 2014, 4(4):e17366.
19.	Atak I, Ozbagriacik M, Akinci OF, et al. Active gas aspiration to reduce pain after laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech, 2011, 21(2):98-100.
20.	Bala I, Bhatia N, Mishra P, et al. Comparison of preoperative oral acetazolamide and intraperitoneal normal saline irrigation for reduction of postoperative pain after laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A, 2015, 25(4):285-290.
21.	Donatsky AM, Bjerrum F, Gögenur I. Intraperitoneal instillation of saline and local anesthesia for prevention of shoulder pain after laparoscopic cholecystectomy:a systematic review. Surg Endosc, 2013, 27(7):2283-2292.
22.	Kahokehr A, Sammour T, Soop M, et al. Intraperitoneal use of local anesthetic in laparoscopic cholecystectomy:systematic review and metaanalysis of randomized controlled trials. J Hepatobiliary Pancreat Sci, 2010, 17(5):637-656.
23.	Castillo-Garza G, Díaz-Elizondo JA, Cuello-García CA, et al. Irrigation with bupivacaine at the surgical bed for postoperative pain relief after laparoscopic cholecystectomy. JSLS, 2012, 16(1):105-111.
24.	Ebrahimifard F, Nooraei N. Postoperative pain after laparoscopic cholecystectomy:a randomized clinical trial comparing intraperitoneal bupivacaine versus intravenous pethidine. Surg Laparosc Endosc Percutan Tech, 2013, 23(1):88-92.
25.	Lin S, Hua J, Xu B, et al. Comparison of bupivacaine and parecoxib for postoperative pain relief after laparoscopic cholecystectomy:a randomized controlled trial. Int J Clin Exp Med, 2015, 8(8):13824-13829.
26.	Upadya M, Pushpavathi SH, Seetharam KR. Comparison of intra-peritoneal bupivacaine and intravenous paracetamol for postoperative pain relief after laparoscopic cholecystectomy. Anesth Essays Res, 2015, 9(1):39-43.
27.	Ahmad A, Faridi S, Siddiqui F, et al. Effect of bupivacaine soaked gauze in postoperative pain relief in laparoscopic cholecystectomy:a prospective observational controlled trial in 120 patients. Patient Saf Surg, 2015, 9:31.
28.	Liu YY, Yeh CN, Lee HL, et al. Local anesthesia with ropivacaine for patients undergoing laparoscopic cholecystectomy. World J Gastroenterol, 2009, 15(19):2376-2380.
29.	王静, 魏威.腹腔内局部应用罗哌卡因对腹腔镜胆囊切除术后疼痛的影响.中国实用医刊, 2012, 39(9):7-9.
30.	吴媛媛, 徐洪刚, 王昊.应用罗哌卡因对腹腔镜胆囊切除术后疼痛效应观察.医学与哲学, 2014, 35(4):22-23.
31.	王美青, 潘寅兵, 钱燕宁.罗哌卡因联合地塞米松腹腔内喷洒对腹腔镜胆囊切除术后疼痛的影响.临床麻醉学杂志, 2012, 28(6):552-554.
32.	Fu JZ, Li J, Yu ZL. Effect of implanting fibrin sealant with ropivacaine on pain after laparoscopic cholecystectomy. World J Gastroenterol, 2009, 15(46):5851-5854.
33.	Yang SY, Kang H, Choi GJ, et al. Efficacy of intraperitoneal and intravenous lidocaine on pain relief after laparoscopic cholecystectomy. J Int Med Res, 2014, 42(2):307-319.
34.	Khan MR, Raza R, Zafar SN, et al. Intraperitoneal lignocaine (lidocaine) versus bupivacaine after laparoscopic cholecystectomy:results of a randomized controlled trial. J Surg Res, 2012, 178(2):662-669.
35.	Akaraviputh T, Leelouhapong C, Lohsiriwat V, et al. Efficacy of perioperative parecoxib injection on postoperative pain relief after laparoscopic cholecystectomy:a prospective, randomized study. World J Gastroenterol, 2009, 15(16):2005-2008.
36.	吴进, 戴甫成, 袁菊芳, 等.切口浸润麻醉复合帕瑞昔布静注用于腹腔镜胆囊切除术后镇痛.临床麻醉学杂志, 2011, 27(4):351-352.
37.	李青, 付群, 茆庆洪, 等.右美托咪定复合帕瑞昔布钠对腹腔镜胆囊切除术后疼痛的影响.临床麻醉学杂志, 2014, 30(10):1015-1017.
38.	Choi YJ, Park SW, Kwon HJ, et al. Efficacy of early intravenous bolus oxycodone or fentanyl in emergence from general anaesthesia and postoperative analgesia following laparoscopic cholecystectomy:a randomized trial. J Int Med Res, 2015, 43(6):809-818.
39.	Zhu Y, Jing G, Yuan W. Preoperative administration of intramuscular dezocine reduces postoperative pain for laparoscopic cholecystectomy. J Biomed Res, 2011, 25(5):356-361.
40.	韩小云.综合保温预防腹腔镜胆囊切除术后肩部疼痛.护理学杂志, 2010, 25(22):53-54.
41.	孙彩艳, 白俊.拔罐护理在LC术后的应用及疗效.世界最新医学信息文摘, 2012, 12(5):148.
42.	暨玲, 叶百亮, 屠金夫, 等.内关穴位按摩预防胆囊切除术后疼痛及恶心呕吐.浙江中医药大学学报, 2010, 34(5):745-746.
43.	郭绍红.董集生.腹腔镜胆囊切除术后疼痛的原因与防治.中国微创外科杂志, 2001, 1(5):308-311.

1. Mitra S, Khandelwal P, Roberts K, et al. Pain relief in laparoscopic cholecystectomy-a review of the current options. Pain Pract, 2012, 12(6):485-496.
2. Donatsky AM, Bjerrum F, Gögenur I. Surgical techniques to minimize shoulder pain after laparoscopic cholecystectomy. A systematic review. Surg Endosc, 2013, 27(7):2275-2282.
3. 韩小云, 戴新娟, 徐静娟, 等.腹腔镜胆囊切除术后并发肩部痛的原因及护理干预研究进展.护理研究, 2012, 26(19):1737-1739.
4. Yasir M, Mehta KS, Banday VH, et al. Evaluation of post operative shoulder tip pain in low pressure versus standard pressure pneumoperitoneum during laparoscopic cholecystectomy. Surgeon, 2012, 10(2):71-74.
5. Kandil TS, El Hefnawy E. Shoulder pain following laparoscopic cholecystectomy:factors affecting the incidence and severity. J Laparoendosc Adv Surg Tech A, 2010, 20(8):677-682.
6. Sandhu T, Yamada S, Ariyakachon V, et al. Low-pressure pneumoperitoneum versus standard pneumoperitoneum in laparoscopic cholecystectomy, a prospective randomized clinical trial. Surg Endosc, 2009, 23(5):1044-1047.
7. Lee JS, Kim EY, Lee SH, et al. A simple method of reducing residual intraperitoneal carbon dioxide after laparoscopic cholecystectomy:a prospective, randomized, controlled study. J Laparoendosc Adv Surg Tech A, 2014, 24(8):563-566.
8. Klugsberger B, Schreiner M, Rothe A, et al. Warmed, humidified carbon dioxide insufflation versus standard carbon dioxide in laparoscopic cholecystectomy:a double-blinded randomized controlled trial. Surg Endosc, 2014, 28(9):2656-2660.
9. 李家福, 周家军.腹腔镜胆囊切除术后上腹痛原因分析.腹腔镜外科杂志, 2010, 15(10):775-776.
10. 李晋, 刘进衡.腹腔镜胆囊切除术后疼痛原因分析.中外健康文摘, 2013, 10(28):63-64.
11. Aitola P, Airo I, Kaukinen S, et al. Comparison of N₂O and CO₂ pneumoperitoneums during laparoscopic cholecystectomy with special reference to postoperative pain. Surg Laparosc Endosc, 1998, 8(2):140-144.
12. Sharp JR, Pierson WP, Brady CE. Comparison of CO₂and N₂O-induced discomfort during peritoneoscopy under local anesthesia. Gastroenterology, 1982, 82(3):453-456.
13. 王建球, 周海华, 史佩东, 等.免气腹及气腹腹腔镜胆囊切除术的对比研究.肝胆外科杂志, 2014, 22(3):184-187.
14. 郑俊城, 彭毅, 钟立明, 等.空气与二氧化碳气腹腹腔镜胆囊切除术的比较.中国微创外科杂志, 2014, 14(5):389-392.
15. 王黎滨.改良气腹法减轻腹腔镜胆囊切除术后疼痛的效果评估.中国中西医结合急救杂志, 2010, 17(1):57.
16. Singla S, Mittal G, Mittal RK. Pain management after laparoscopic cholecystectomy-a randomized prospective trial of low pressure and standard pressure pneumoperitoneum. J Clin Diagn Res, 2014, 8(2):92-94.
17. 申海军, 陈广瑜, 詹建兴, 等.腹腔镜胆囊切除术气腹压力、手术时间对肝功能、颈肩痛及恶心呕吐的影响.中国现代医药杂志, 2012, 14(1):58-60.
18. Sabzi Sarvestani A, Zamiri M. Residual pneumoperitoneum volume and postlaparoscopic cholecystectomy pain. Anesth Pain Med, 2014, 4(4):e17366.
19. Atak I, Ozbagriacik M, Akinci OF, et al. Active gas aspiration to reduce pain after laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech, 2011, 21(2):98-100.
20. Bala I, Bhatia N, Mishra P, et al. Comparison of preoperative oral acetazolamide and intraperitoneal normal saline irrigation for reduction of postoperative pain after laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A, 2015, 25(4):285-290.
21. Donatsky AM, Bjerrum F, Gögenur I. Intraperitoneal instillation of saline and local anesthesia for prevention of shoulder pain after laparoscopic cholecystectomy:a systematic review. Surg Endosc, 2013, 27(7):2283-2292.
22. Kahokehr A, Sammour T, Soop M, et al. Intraperitoneal use of local anesthetic in laparoscopic cholecystectomy:systematic review and metaanalysis of randomized controlled trials. J Hepatobiliary Pancreat Sci, 2010, 17(5):637-656.
23. Castillo-Garza G, Díaz-Elizondo JA, Cuello-García CA, et al. Irrigation with bupivacaine at the surgical bed for postoperative pain relief after laparoscopic cholecystectomy. JSLS, 2012, 16(1):105-111.
24. Ebrahimifard F, Nooraei N. Postoperative pain after laparoscopic cholecystectomy:a randomized clinical trial comparing intraperitoneal bupivacaine versus intravenous pethidine. Surg Laparosc Endosc Percutan Tech, 2013, 23(1):88-92.
25. Lin S, Hua J, Xu B, et al. Comparison of bupivacaine and parecoxib for postoperative pain relief after laparoscopic cholecystectomy:a randomized controlled trial. Int J Clin Exp Med, 2015, 8(8):13824-13829.
26. Upadya M, Pushpavathi SH, Seetharam KR. Comparison of intra-peritoneal bupivacaine and intravenous paracetamol for postoperative pain relief after laparoscopic cholecystectomy. Anesth Essays Res, 2015, 9(1):39-43.
27. Ahmad A, Faridi S, Siddiqui F, et al. Effect of bupivacaine soaked gauze in postoperative pain relief in laparoscopic cholecystectomy:a prospective observational controlled trial in 120 patients. Patient Saf Surg, 2015, 9:31.
28. Liu YY, Yeh CN, Lee HL, et al. Local anesthesia with ropivacaine for patients undergoing laparoscopic cholecystectomy. World J Gastroenterol, 2009, 15(19):2376-2380.
29. 王静, 魏威.腹腔内局部应用罗哌卡因对腹腔镜胆囊切除术后疼痛的影响.中国实用医刊, 2012, 39(9):7-9.
30. 吴媛媛, 徐洪刚, 王昊.应用罗哌卡因对腹腔镜胆囊切除术后疼痛效应观察.医学与哲学, 2014, 35(4):22-23.
31. 王美青, 潘寅兵, 钱燕宁.罗哌卡因联合地塞米松腹腔内喷洒对腹腔镜胆囊切除术后疼痛的影响.临床麻醉学杂志, 2012, 28(6):552-554.
32. Fu JZ, Li J, Yu ZL. Effect of implanting fibrin sealant with ropivacaine on pain after laparoscopic cholecystectomy. World J Gastroenterol, 2009, 15(46):5851-5854.
33. Yang SY, Kang H, Choi GJ, et al. Efficacy of intraperitoneal and intravenous lidocaine on pain relief after laparoscopic cholecystectomy. J Int Med Res, 2014, 42(2):307-319.
34. Khan MR, Raza R, Zafar SN, et al. Intraperitoneal lignocaine (lidocaine) versus bupivacaine after laparoscopic cholecystectomy:results of a randomized controlled trial. J Surg Res, 2012, 178(2):662-669.
35. Akaraviputh T, Leelouhapong C, Lohsiriwat V, et al. Efficacy of perioperative parecoxib injection on postoperative pain relief after laparoscopic cholecystectomy:a prospective, randomized study. World J Gastroenterol, 2009, 15(16):2005-2008.
36. 吴进, 戴甫成, 袁菊芳, 等.切口浸润麻醉复合帕瑞昔布静注用于腹腔镜胆囊切除术后镇痛.临床麻醉学杂志, 2011, 27(4):351-352.
37. 李青, 付群, 茆庆洪, 等.右美托咪定复合帕瑞昔布钠对腹腔镜胆囊切除术后疼痛的影响.临床麻醉学杂志, 2014, 30(10):1015-1017.
38. Choi YJ, Park SW, Kwon HJ, et al. Efficacy of early intravenous bolus oxycodone or fentanyl in emergence from general anaesthesia and postoperative analgesia following laparoscopic cholecystectomy:a randomized trial. J Int Med Res, 2015, 43(6):809-818.
39. Zhu Y, Jing G, Yuan W. Preoperative administration of intramuscular dezocine reduces postoperative pain for laparoscopic cholecystectomy. J Biomed Res, 2011, 25(5):356-361.
40. 韩小云.综合保温预防腹腔镜胆囊切除术后肩部疼痛.护理学杂志, 2010, 25(22):53-54.
41. 孙彩艳, 白俊.拔罐护理在LC术后的应用及疗效.世界最新医学信息文摘, 2012, 12(5):148.
42. 暨玲, 叶百亮, 屠金夫, 等.内关穴位按摩预防胆囊切除术后疼痛及恶心呕吐.浙江中医药大学学报, 2010, 34(5):745-746.
43. 郭绍红.董集生.腹腔镜胆囊切除术后疼痛的原因与防治.中国微创外科杂志, 2001, 1(5):308-311.

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Causes and Preventions of Pain after Laparoscopic Cholecystectomy

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