New options for treating acute pain after laparoscopic cholecystectomy
Background. Acute postoperative pain after laparoscopic cholecystectomy remains a pressing problem of modern medicine. Its ineffective treatment adversely affects the patient’s condition and the recovery time after surgery and also has a high risk of formation of chronic pain. Therefore, in the trea...
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| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
Zaslavsky O.Yu.
2025-06-01
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| Series: | Медицина неотложных состояний |
| Subjects: | |
| Online Access: | https://emergency.zaslavsky.com.ua/index.php/journal/article/view/1881 |
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| Summary: | Background. Acute postoperative pain after laparoscopic cholecystectomy remains a pressing problem of modern medicine. Its ineffective treatment adversely affects the patient’s condition and the recovery time after surgery and also has a high risk of formation of chronic pain. Therefore, in the treatment of acute postoperative pain, it is recommended to combine pharmacotherapy with regional analgesia. One of these techniques is the quadratus lumborum (QL) block type II. The aim of our study was to compare and evaluate the effectiveness of postoperative pain control when using multimodal analgesia and when combining it with a right-sided QL block in patients with acute cholecystitis who underwent laparoscopic surgery. Materials and methods. We examined 62 patients with acute cholecystitis who underwent laparoscopic surgery. The level of pain on the visual analog scale, hemodynamic parameters, glycemia level, frequency of nausea/vomiting, time to recovery of peristalsis, time to first getting out of bed, need for additional anesthesia, subjective assessment of sleep quality, level of daytime sleepiness (Epworth Sleepiness Scale), anxiety (Beck Anxiety Inventory), anxiety and depression (Beck Depression Inventory and Hospital Anxiety and Depression Scale) were evaluated. Results. On admission, patients with acute cholecystitis had moderate pain (5.47 ± 0.39 — 5.69 ± 4.30 points on the visual analog scale) both at rest and during movement, which was accompanied by nausea and/or vomiting in 36.7–37.5 % of cases. In the early postoperative period, when using the QL block, the pain level was significantly lower than in the control group starting from first hour after surgery with a maximum effect after 2, 4 and 12 hours. At the same time, a decrease in tachycardia by 13.8–16.1 % (p < 0.001) and in the frequency of postoperative nausea and vomiting by 18.6–20.4 % (p < 0.001) was found. Recovery of peristalsis in the QL block group was observed 6 hours earlier (p < 0.001), and patient activation — 2.5 hours earlier (p = 0.021). A significant improvement in sleep quality was found in the QL block group during the first three days after surgery, which led to a decrease in daytime sleepiness, and was also accompanied by a low level of anxiety and depression. Conclusions. In patients with acute cholecystitis who underwent laparoscopic surgery, the extension of multimodal analgesia by performing a right-sided QL block allowed reducing the level of pain to moderate, both at rest and during movement; avoid the use of narcotic analgesics; reduce the frequency of nausea and vomiting, as well as accelerate the motor function of the intestine and the patient’s activation. Against the background of a decrease in the level of postoperative pain syndrome, the psycho-emotional state of patients was improved through better quality of night sleep and the absence of daytime sleepiness. |
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| ISSN: | 2224-0586 2307-1230 |