A COMPARISON OF ANALGESIC REQUIREMENTS AND PULMONARY-FUNCTION IN OPENVERSUS LAPAROSCOPIC CHOLECYSTECTOMY

Laparoscopic cholecystectomy has rapidly become the treatment of choic e for uncomplicated cholelithiasis. Its adoption has come in the absen ce of traditional randomized trials. This study compares analgesic req uirements and pulmonary function in two randomized case controlled gro ups of patients, one group having the traditional laparotomy or 'open' cholecystectomy (n = 14) and the other laparoscopic cholecystectomy ( n = 18). Pulmonary function tests (FEV1/FVC) and visual analogue scale s were scored at 3, 6, and 24 h following surgery and narcotic require ments over this period were also logged. In the 'open' group, the mean narcotic requirement in the first 24 h was 133 mg papaveretum per pat ient (range 60-200), but was significantly (Student t-test P < 0.05) l ess in the laparoscopic group at 42 mg per patient (range 20-60). Visu al analogue scores were also better: 3.6 versus 5.9 at 3 h, 3.0 versus 6.6 at 6 h and 1.1 versus 4.3 at 24 h. Overall results for pulmonary function in the laparoscopic group showed that at 24 h following surge ry, the mean FEV1 was 73.2% (range 57-87) of the pre-operative value v ersus 37.8% (range 20-66) in the 'open' group. The mean value for FVC at 24 h in the laparoscopic patients was 78% of the pre-operative valu e (range 61-93) compared with 44% (range 29-63) in the 'open' group. T hese results support the clinical impression that the laparoscopic app roach results in significantly less analgesic requirements and better pulmonary function in patients undergoing cholecystectomy for uncompli cated cholelithiasis.