Aims:

To evaluate efficacy and security with a multimodal preventive analgesic technique (intravenous paracetamol, ibuprofen, dexametasone and local anesthetic infiltration incision) in postoperative pain management after laparoscopic cholecystectomy.

Methodology:

Observational prospective study in laparoscopic cholecystectomy under common anesthetiå(c)using intravenous ibuprofen (800 mg), paracetamol (1 g), dexamethasone (0.1 mg/kg) and 0.5 % bupivacaine portals infiltration. Analgesic rescue with metamizole (2 g) and morphine clorure (1 mg boluses). We noted pain grade, rescue analgesia, anesthetic-chirurgic complications and satisfaction level at five moments: in UCPA stay (20 min and 2 h after surgery and before discharge) and 24 h after surgery.

Results:

112 patients: 71 women and 41 men, 61.15 ± 16.23 aged; 76.20 ± 12.68 kg weight, surgery time of 92.11 ± 30.64 minutes; 1.91 ± 15,78 microgrames/kg/h fentanyl doses; ASA I (34,8 %), II (40,2 %), III (22,3 %) y IV (2,7 %). Two maximum pain peaks: at 20 min and at 24 h after the intervention and during movement. Severe pain and additional analgesia in 23 cases, and need for morphine chloride boluses in 6. Thirty cases complications were documented: emesis in 17 people (15.18 %), venous irritability in 10 cases (8.93 %) and hemodynamic instability in 3 cases (2.68 %).

Conclusions:

The multimodal analgesic strategy used in this study provided effective analgesia with fast, high-quality anesthetic-surgical recovery in most patients. In case it was need, low perioperative opioid requirements. Low rate and severity of perioperative complications, which facilitated high outpatient surgery rates.

        · |     · |     · ( pdf )