• H Kehlet, A W Gray, F Bonnet, F Camu, H B J Fischer, R F McCloy, E A M Neugebauer, M M Puig, N Rawal, and C J P Simanski.
• Section for Surgical Pathophysiology, 4074, The Juliane Marie Centre, Rigshospitalet, Denmark. henrik.kehlet@rh.dk
• Surg Endosc. 2005 Oct 1;19(10):1396-415.

BackgroundLaparoscopic cholecystectomy has advantages over the open procedure for postoperative pain. However, a systematic review of postoperative pain management in this procedure has not been conducted.MethodsA systematic review was conducted according to the guidelines of the Cochrane Collaboration. Randomized studies examining the effect of medical or surgical interventions on linear pain scores in patients undergoing laparoscopic cholecystectomy were included. Qualitative and quantitative analyses were performed. Recommendations for patient care were derived from review of these data, evidence from other relevant procedures, and clinical practice observations collated by the Delphi method among the authors.ResultsSixty-nine randomized trials were included and 77 reports were excluded. Recommendations are provided for preoperative analgesia, anesthetic and operative techniques, and intraoperative and postoperative analgesia.ConclusionsA step-up approach to the management of postoperative pain following laparoscopic cholecystectomy is recommended. This approach has been designed to provide adequate analgesia while minimizing exposure to adverse events.

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