PREOPERATIVE MULTIMODAL ANALGESIA FACILITATES RECOVERY AFTER AMBULATORY LAPAROSCOPIC CHOLECYSTECTOMY

Laparoscopy approach to cholecystectomy has shortened the recovery per iod, reducing discharge times from 1 to 3 days to same-day discharge. We hypothesize that the use of more than one modality to prevent posto perative pain may be more efficacious than single modality. Patients w ere randomized to a treatment (n = 24) or control (n = 25) group and s tudied using a prospective, double-blind design. Preoperatively, at 45 min before induction of anesthesia, the treatment group received an i ntramuscular (IM) bolus injection of meperidine 0.6 mg/kg and ketorola c 0.5 mg/kg. The control group received two bolus IM injections of pla cebo (normal saline). Ten minutes before incision, local anesthesia (t reatment group) or saline (control group) was infiltrated into the ski n of each patient. Anesthetic management, postoperative pain, and naus ea treatment were standardized. Pain and nausea assessment were done 1 h preoperatively, 0, 0.5, 1, 2, 3, and 4 h postoperatively, at discha rge, and 10, 24, and 48 h postoperatively. Patients were discharged by scoring criteria. Postoperatively, significantly more patients in the treatment group were without pain on arrival in the postanesthesia ca re unit (PACU), 12/21 (57.1%) vs 1/24 (4.2%) in the control group (P < 0.001). Similarly, the severity of pain was sixfold less in the treat ment group than in the control group. The incidence of nausea in the P ACU was significantly less in the treatment group; 4.7% vs 29.5% in th e control group (P < 0.05). Patients from the treatment group satisfie d Postanesthesia Discharge Score significantly earlier than those in t he control group (281 +/- 12 min vs 375 +/- 19 min; P <005). The conco mitant use of local anesthetic and nonsteroidal antiinflammatory and o pioid drugs proved to be highly effective in our patients, resulting i n faster recovery and discharge.