South Auckland Clinical School, University of Auckland, Department of Surgery, Middlemore Hospital, Auckland, New Zealand.
South Auckland Clinical School, University of Auckland, Department of Surgery, Middlemore Hospital, Auckland, New Zealand.
Br J Anaesth. 2018 Oct;121(4):787-803. doi: 10.1016/j.bja.2018.06.023. Epub 2018 Aug 7.
Significant pain can be experienced after laparoscopic cholecystectomy. This systematic review aims to formulate PROSPECT (PROcedure SPECific Postoperative Pain ManagemenT) recommendations to reduce postoperative pain after laparoscopic cholecystectomy.
Randomised controlled trials published in the English language from January 2006 (date of last PROSPECT review) to December 2017, assessing analgesic, anaesthetic, or operative interventions for laparoscopic cholecystectomy in adults, and reporting pain scores, were retrieved from MEDLINE and Cochrane databases using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) search protocols. PROSPECT methodology was used, and recommendations were formulated after review and discussion by the PROSPECT group (an international group of leading pain specialists and surgeons).
Of 1988 randomised controlled trials identified, 258 met the inclusion criteria and were included in this review. The studies were of mixed methodological quality, and quantitative analysis was not performed because of heterogeneous study design and how outcomes were reported.
We recommend basic analgesic techniques: paracetamol + NSAID or cyclooxygenase-2 specific inhibitor + surgical site local anaesthetic infiltration. Paracetamol and NSAID should be started before or during operation with dexamethasone (GRADE A). Opioid should be reserved for rescue analgesia only (GRADE B). Gabapentanoids, intraperitoneal local anaesthetic, and transversus abdominis plane blocks are not recommended (GRADE D) unless basic analgesia is not possible. Surgically, we recommend low-pressure pneumoperitoneum, postprocedure saline lavage, and aspiration of pneumoperitoneum (GRADE A). Single-port incision techniques are not recommended to reduce pain (GRADE A).
腹腔镜胆囊切除术（LC）后可能会出现明显的疼痛。本系统评价旨在制定 PROSPECT（手术特定术后疼痛管理）建议，以减轻 LC 后的术后疼痛。
从 MEDLINE 和 Cochrane 数据库中检索了 2006 年 1 月（上次 PROSPECT 综述的日期）至 2017 年 12 月期间发表的评估成人 LC 中镇痛、麻醉或手术干预的英文随机对照试验，检索使用了 PRISMA（系统评价和荟萃分析的首选报告项目）搜索协议，报告了疼痛评分。采用 PROSPECT 方法，由 PROSPECT 小组（一组国际领先的疼痛专家和外科医生）进行审查和讨论后制定建议。
在 1988 项随机对照试验中，有 258 项符合纳入标准，并纳入了本综述。这些研究的方法学质量参差不齐，由于研究设计和结果报告方式存在异质性，因此未进行定量分析。
我们建议采用基本的镇痛技术：扑热息痛+非甾体抗炎药或环氧化酶-2 特异性抑制剂+手术部位局部麻醉浸润。扑热息痛和非甾体抗炎药应在手术前或手术时与地塞米松一起使用（A级）。阿片类药物应仅作为解救性镇痛剂（B 级）。加巴喷丁类药物、腹腔内局部麻醉和腹横肌平面阻滞除非基本镇痛不可能，否则不推荐使用（D 级）。手术方面，我们建议使用低压气腹、术后盐水冲洗和腹腔内气腹抽吸（A级）。不建议采用单孔切口技术来减轻疼痛（A级）。
