Bisgaard T, Kehlet H, Rosenberg J
Department of Surgical Gastroenterology, University of Copenhagen, Hvidovre Hospital, Hvidovre, Denmark.
Eur J Surg. 2001 Feb;167(2):84-96. doi: 10.1080/110241501750070510.
Pain and speed of convalescence are the two main problems after uncomplicated laparoscopic cholecystectomy. We therefore identified interventional and descriptive studies in electronic databases and supplemented them with manual searches. Pain and interventional analgesic studies were analysed with reference to the effects on specific pain components after laparoscopic cholecystectomy. Convalescence and factors associated with early recovery were also analysed. Pain after cholecystectomy is most intense for the first 2-3 days with a high interindividual variability and dominated by incisional pain rather than other pain components. Early pain after cholecystectomy is reduced by minimising residual pneumoperitoneum and by giving incisional local anaesthetics, epidural analgesia, and non-steroidal anti-inflammatory drugs. There are inconclusive data about type and pressure of pneumoperitoneum, the use of intraperitoneal local anaesthetics, and the type of general anaesthesia. Pain and medico-cultural traditions are the main factors responsible for prolonged convalescence after laparoscopic cholecystectomy. To minimise pain and the duration of convalescence, we recommend multi-modal analgesic treatment in combination with short, standardised instructions to resume work and normal activity.
疼痛和康复速度是单纯性腹腔镜胆囊切除术后的两个主要问题。因此，我们在电子数据库中检索了干预性和描述性研究，并通过手工检索进行补充。参考腹腔镜胆囊切除术后对特定疼痛成分的影响，对疼痛和干预性镇痛研究进行了分析。还分析了康复情况以及与早期恢复相关的因素。胆囊切除术后的疼痛在最初2至3天最为剧烈，个体差异很大，主要是切口疼痛而非其他疼痛成分。通过尽量减少残余气腹以及给予切口局部麻醉、硬膜外镇痛和非甾体类抗炎药，可以减轻胆囊切除术后的早期疼痛。关于气腹的类型和压力、腹腔内局部麻醉的使用以及全身麻醉的类型，数据尚无定论。疼痛和医学文化传统是腹腔镜胆囊切除术后康复时间延长的主要因素。为了尽量减轻疼痛和缩短康复时间，我们建议采用多模式镇痛治疗，并结合简短、标准化的恢复工作和正常活动的指导。
