PROSPECT collaboration members are listed in the Appendix.
Evidence-based postoperative pain management after laparoscopic colorectal surgery
Article first published online: 25 JAN 2013
© 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland
Volume 15, Issue 2, pages 146–155, February 2013
How to Cite
Joshi, G. P., Bonnet, F., Kehlet, H. and on behalf of the PROSPECT collaboration (2013), Evidence-based postoperative pain management after laparoscopic colorectal surgery. Colorectal Disease, 15: 146–155. doi: 10.1111/j.1463-1318.2012.03062.x
- Issue published online: 25 JAN 2013
- Article first published online: 25 JAN 2013
- Accepted manuscript online: 30 APR 2012 10:23AM EST
- Received 16 January 2012; accepted 3 March 2012; Accepted Article online 30 April 2012
- Laparoscopic colorectal surgery;
- pain, analgesia;
- systematic review;
- evidence-based medicine
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.