PAIN AFTER LAPAROSCOPIC CHOLECYSTECTOMY - INTENSITY AND LOCALIZATION OF PAIN AND ANALYSIS OF PREDICTORS IN PREOPERATIVE SYMPTOMS AND INTRAOPERATIVE EVENTS

It is postulated that laparoscopic cholecystectomy as ''patient-friend ly surgery'' leads to more comfort and in particular to less pain. A p rospective study on pain was performed on all patients undergoing the operation over the period of 1 year (n = 382) out of a series of more than 1,000 patients who have undergone the operation in our clinic. Pa in was measured by a 100-point visual analogue scale (VAS), by a five- point verbal rating scale, and by the consumption of analgesics. Pain was the most frequent symptom, both before and after the operation. Th e mean level of pain was 37 VAS points 5 h after the operation and dec lined to 16 points on the third day. In 106 patients (27.8%) the inten sity of pain was higher than 50 VAS points. Analgesics were used by 28 2 patients (73.8%), opioids by 112 (29.3%). Pain was significantly hig her in female than male patients (P < 0.05), but consumption of analge sics was similar in both groups. The most severe pain was localized to the abdominal wall wounds by 157 (41.1%) and to the right upper abdom en by 138 patients (36.1%) on the first postoperative day. Patients wh o needed opioids and/or had a pain level of >50 VAS points (n = 138) h ad higher preoperative pain levels (P = 0.018) and preoperatively comp lained more frequently about nausea, vomiting, bloating, and a feeling of abdominal pressure (P = 0.003-0.031). However, predictive values o f these variables were too small to be of clinical benefit. The durati on of operation, intraoperative events (loss of bile, blood, or gallst ones), and additional laparoscopic procedures (adhesiolysis, lavage, e xtension of an incision, suture of fascia) did not influence the inten sity of postoperative pain. We conclude that laparoscopic cholecystect omy did cause significant postoperative pain in one-third of our patie nts only up to the first postoperative day. As predictors for high int ensity of pain were not identified, pain should be monitored and analg esics should be delivered liberally.