POSTOPERATIVE ANALGESIA - A COMPARISON BE TWEEN LAPAROSCOPIC CHOLECYSTECTOMY AND LOWER ABDOMINAL LAPAROTOMY

From September 1992 through February 1993 27 randomly chosen female pa tients were evaluated for differences in postoperative pain intensity (as determined by visual-analogue-scale (VAS)) and analgesic requireme nts via patient-controlled-analgesia (PCA), either after open lower-ab dominal-laparotomy (n=16, group 1) or after minimal-invasive-cholecyst ectomy (n=11, group 2). The type of anaesthesia has been standardized, either as balanced or total intravenous anaesthesia. There were no st atistically significant differences between the groups regarding to ag e, height, weight, intraoperative anaesthetic drug consumption, or dur ation of anaesthesia and surgery (205,6 vs 185,5 minutes; 139,1 vs 105 ,0 minutes). All patients could be extubated while still in the operat ion theatre. The 10-hour study period started after transfer to the re covery room. Heart- and respiratory-rate, systolic/diastolic blood pre ssure, endtidal pCO(2), oxygen-saturation via pulsoxymetry (SaO(2)), a nd demands from PCA-pump were recorded, furthermore pain scores were d etermined every hour. The VAS-scores showed no significant differences between the two groups. The pain level as a whole was low, with the s cores ranging from a maximum of 23,4 mm (group 1 after the first hour) to a minimum of 1,8 mm (group 2 after 5, 8 an 10 hours). The overall analgesic requirements differred significantly (37,7 vs 17,3 mg piritr amid, p<.01). There was a difference throughout the whole study period , although statistically significant only at the 1., 2. (p<.05), 5. an d 6.-8. hour (p<.01). This study showed that pain scores were similar after laparoscopic upper or open lower abdominal surgery, both requiri ng adequate analgesic therapy. With the application of piritramid via PCA, postoperative pain after these procedures could be managed satisf actory. Therefore this approach seems to be recommendable.