Document Detail


Evidence-based postoperative pain management after laparoscopic colorectal surgery.
MedLine Citation:
PMID:  23350836     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIM: The aim of this systematic review was to evaluate the available literature on the management of pain after laparoscopic colorectal surgery.
METHOD: Randomized studies, published in English between January 1995 and July 2011, assessing analgesic and anaesthetic interventions in adults undergoing laparoscopic colorectal surgery, and reporting pain scores, were retrieved from the Embase and MEDLINE databases. The efficacy and adverse effects of the analgesic techniques was assessed. The recommendations were based on procedure-specific evidence from a systematic review and supplementary transferable evidence from other relevant procedures.
RESULTS: Of the 170 randomized studies identified, 12 studies were included. Overall, all approaches including ketorolac, methylprednisolone, intraperitoneal instillation of ropivacaine, intravenous lidocaine infusion, intrathecal morphine and epidural analgesia improved pain relief, reduced opioid requirements and improved bowel function. However, there were significant differences in the study designs and the variables evaluated, precluding quantitative analysis. The L'Abbé plots of the data from the epidural analgesia studies included in this review indicate that the pain scores in the nonepidural groups, although higher than those in the epidural groups, were within an acceptable level (i.e. < 4/10).
CONCLUSION: Infiltration of surgical incisions with local anaesthetic at the end of surgery, systemic steroids, conventional nonsteroidal anti-inflammatory drugs or cyclooxygenase-2-selective inhibitors in combination with paracetamol with opioid used as rescue are recommended. Intravenous lidocaine infusion is recommended, but not as the first line of therapy. However, neuraxial blocks (i.e. epidural analgesia and spinal morphine) are not necessary based on high risk:benefit ratio.
Authors:
G P Joshi; F Bonnet; H Kehlet;
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland     Volume:  15     ISSN:  1463-1318     ISO Abbreviation:  Colorectal Dis     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-28     Completed Date:  2013-07-10     Revised Date:  2013-11-06    
Medline Journal Info:
Nlm Unique ID:  100883611     Medline TA:  Colorectal Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  146-55     Citation Subset:  IM    
Copyright Information:
© 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.
Affiliation:
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical School, Dallas, Texas 75390-9068, USA. girish.joshi@utsouthwestern.edu
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MeSH Terms
Descriptor/Qualifier:
Analgesics / administration & dosage*,  adverse effects
Colorectal Surgery* / instrumentation,  methods
Evidence-Based Medicine
Humans
Laparoscopy
Pain, Postoperative / drug therapy*
Randomized Controlled Trials as Topic
Chemical
Reg. No./Substance:
0/Analgesics
Investigator
Investigator/Affiliation:
F Bonnet / ; F Camu / ; H B J Fischer / ; G P Joshi / ; E A M Neugebauer / ; N Rawal / ; S A Schug / ; C J P Simanski / ; H Kehlet /
Comments/Corrections
Comment In:
Colorectal Dis. 2013 Sep;15(9):1186   [PMID:  23701434 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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