Pain after laparoscopic cholecystectomy

Background: Although laparoscopic cholecystectomy (LC) results in less pain than open cholecystectomy, it is not a pain-free procedure. Many methods o f analgesia for pain after laparoscopy have been evaluated. Methods: Forty-two randomized controlled trials assessing interventions to reduce pain after LC are reviewed, as are the mechanisms and nature of pain after this procedure. Results: Non-steroidal anti-inflammatory drugs, wound local anaesthetic, in traperitoneal local anaesthetic, intraperitoneal saline, a gas drain, heate d gas, low-pressure gas and nitrous oxide pneumoperitoneum have been shown to reduce pain after LC. The clinical significance of this pain reduction i s questionable. Conclusion: Pain after LC is multifactorial. Although many methods of analg esia produce short-term benefit, this does not equate with earlier discharg e or improved postoperative function. However, single trials evaluating low -pressure insufflation, heated gas and multimodal analgesia suggest that cl inically relevant benefits can be achieved.