An audit to study pain after laparoscopic cholecystectomy with the use of nonopioid analgesics

Back ground: An Audit to study pain after laparoscopic cholecystectomy with the use of non-opioid analgesics. Patient and Methods: Hundred and nine patients were enrolled in this study that underwent elective laparoscopic cholecystectomy. Aged between 20 – 55 years, patients of either gender were enrolled in this prospective observational study. Seven patients were excluded from the study because of the conversion of laparoscopic procedure to open cholecystectomy and two patients were lost to follow-up. These patients were instructed and taught how to use the Numerical Pain Rating Scale (NPRS) for assessment of pain at rest, during deep breath and on movement. Pain score at rest, deep breath and movement including (Mild, Moderate and Severe pain), dynamic pain, breakthrough episodes of pain and time to discharge post surgery were recorded. Results: We found that none of the patients had severe pain at rest at any time interval. Only 1 patient had severe pain with deep breath at 2 hours and 2 patients had severe pain with deep breath at 6 hours after surgery. 2 patients had severe pain with movement at 2 hours and 6 patients had severe pain with movement at 6 hours after surgery. The dynamic pain was present in 12% patients (12) at 2 hours after surgery, which progressively declined to 4% (4) at 12 hours post surgery. The total number of breakthrough episodes was higher in patients having dynamic-pain at 2 hours. Conclusion: Maximum pain scores were found at 6 hours. Patients having higher dynamic pain score values at 2 hours have frequent breakthrough episodes (p value < 0.05) so an optimal analgesic control is warranted in such subset of patients. The time to discharge of patients was positively correlated to the pain scores of postoperative day 1