Comparative study of pain level and analgesic requirement after laparoscopic and open cholecystectomy.

The laparoscopic technique of cholecystectomy leads to shorter hospitalization, faster recuperation, and earlier return to economic activity. Although reduction in pain is considered a major factor, no objective clinical trial has confirmed this assumption. This prospective trial compared the pain level of laparoscopic (n = 28) and conventional (n = 11) cholecystectomy. The level of pain was determined by an independent observer using the visual analog scale (VAS). Intramuscular pethidine or oral naproxen was given intermittently on demand. Patients who underwent the laparoscopic procedure had significantly less pain on the day of operation (mean VAS score 3.8 vs 7.7) and on the first postoperative day (mean VAS score 2.8 vs 6.2) (p < 0.05). The proportion of patients requiring intramuscular pethidine was correspondingly less in the laparoscopy group. On the second and third postoperative day, the level of pain was not statistically different. All patients who had conventional cholecystectomy required at least one dose of analgesia (pethidine or naproxen), whereas only 53.6% of patients who had the laparoscopic procedure required analgesia (p < 0.05). This study verifies that pain reduction is an important advantage of laparoscopic cholecystectomy.