Effect of multimodal analgesia in laparoscopic colecistectomy in outpatient regime

Abstract

Resultados: Se operaron 320 pacientes, de los cuales 224 fueron incluídos en el estudio: 174 pacientes con infiltración y 47 sin infiltración. La media de edad fue de 48 años (16-81), con predominio del sexo femenino (4:1) y un porcentaje de ASA I-II del 87%. El tiempo quirúrgico medio fue de 49 minutos (10-120). No se halló disminución de las náuseas y vómitos. El grado del dolor fue estadísticamente significativo (p<0.001) en el grupo con irrigación con bupivacaína. Conclusión: La irrigación con bupivacaína en el lecho quirúrgico y los puertos de entrada en las colecistectomías laparoscópicas, controla el dolor durante las primeras 24 horas en los pacientes de CMA Abstract Objective: The objective of this study was to determine the effectiveness of local anesthetic infiltration at ports of entry and surgical laparoscopic cholecystectomy in ambulatory major surgery. The use of bupivacaine could reduce postoperative pain favoring early discharge. Methods: The present study is a retrospective analysis of patients operated on laparoscopic cholecystectomy in CMA from January, 2015 to March, 2017. The effect of infiltration with bupivacaine (20 mL at 0.5%) at ports of entry was analyzed such as peritoneal instillation in the diaphragm and surgical bed. During the postoperative period all patients followed the protocol of analgesia with paracetamol 1gr + metamizol 2gr. As rescue treatment 50 mg of dexketoprofen IV was used. Pain was analyzed according to the EVA scale, as well as nausea and vomiting during the immediate postoperative period and discharge in the outpatient setting. Categorical data were compared with percentages and Fischer’s test. For the nausea and vomiting the Chi square method was followed. To analyze the pain, the general linear method was followed. Results: 320 patients were operated, of which 224 were included in the study: 174 patients with infiltration and 47 without infiltration. The mean age was 48 years (16-81), with predominance of females (4: 1) and a percentage of ASA I-II of 87%. The mean surgical time was 49 minutes (10-120). No decrease in nausea and vomiting was found. The degree of pain was statistically significant (p <0.001) in the group with irrigation with bupivacaine. Conclusion: Irrigation with bupivacaine in the surgical bed and the ports of entry in laparoscopic cholecystectomies controls pain during the first 24 hours in AMC patients.