Pain after laparoscopy

Background: In the context of the much-heralded advantages of laparoscopic surgery, it can be easy to overlook postlaparoscopy pain as a serious probl em, yet as many as 80% of patients will require opioid analgesia. It genera lly is accepted that pain after laparoscopy is multifactorial, and the surg eon is in a unique position to influence many of the putative causes by rel atively minor changes in technique. Methods: This article reviews the relevant literature concerning the topic of pain after laparoscopy. Results: The following factors, in varying degrees, have been implicated in postlaparoscopy pain: distension-induced neuropraxia of the phrenic nerves , acid intraperitoneal milieu during the operation, residual intra-abdomina l gas after laparoscopy, humidity of the insufflated gas, volume of the ins ufflated gas, wound size, presence of drains, anesthetic drugs and their po stoperation effects, and sociocultural and individual factors. Conclusions: On the basis of the factors implicated in postlaparoscopy pain , the following recommendations can be made in an attempt to reduce such pa in: emphathically consider each patients' unique sociocultural and individu al pain experience; inject port sites with local anesthesia at the start of the operation; keep intra-abdominal pressure during pneumoperitoneum below 15 mmHg, avoiding pressure peaks and prolonged insufflation; use humidifie d gas at body temperature if available; use nonsteroidal anti-inflammatory drugs at the time of induction; attempt to evacuate all intraperitoneal gas at the end of the operation; and use drains only when required, rather tha n as a routine.