{"id":3143,"date":"2021-05-19T13:59:28","date_gmt":"2021-05-19T10:59:28","guid":{"rendered":"https:\/\/www.esrahellas.gr\/?page_id=3143"},"modified":"2021-07-14T19:53:02","modified_gmt":"2021-07-14T16:53:02","slug":"laparoscopic-cholecystectomy","status":"publish","type":"page","link":"https:\/\/www.esrahellas.gr\/en\/prospect-recommendations\/laparoscopic-cholecystectomy\/","title":{"rendered":"Laparoscopic Cholecystectomy"},"content":{"rendered":"  <div id=\"page-header-83525610\" class=\"page-header-wrapper\">\n  <div class=\"page-title dark featured-title\">\n\n    \n    <div class=\"page-title-inner container align-center flex-row medium-flex-wrap\" >\n              <div class=\"title-wrapper flex-col text-left medium-text-center\">\n          <h1 class=\"entry-title mb-0\">\n            Laparoscopic Cholecystectomy          <\/h1>\n        <\/div>\n                    <div class=\"title-content flex-col flex-right text-right medium-text-center\">\n        <div class=\"title-share pt-half pb-half\"><div class=\"social-icons share-icons share-row relative icon-style-fill\" ><a href=\"https:\/\/www.facebook.com\/sharer.php?u=https:\/\/www.esrahellas.gr\/en\/prospect-recommendations\/laparoscopic-cholecystectomy\/\" data-label=\"Facebook\" onclick=\"window.open(this.href,this.title,'width=500,height=500,top=300px,left=300px'); return false;\" target=\"_blank\" class=\"icon primary button circle tooltip facebook\" title=\"Share on Facebook\" aria-label=\"Share on Facebook\" rel=\"noopener nofollow\"><i class=\"icon-facebook\" aria-hidden=\"true\"><\/i><\/a><a href=\"https:\/\/twitter.com\/share?url=https:\/\/www.esrahellas.gr\/en\/prospect-recommendations\/laparoscopic-cholecystectomy\/\" onclick=\"window.open(this.href,this.title,'width=500,height=500,top=300px,left=300px'); return false;\" target=\"_blank\" class=\"icon primary button circle tooltip twitter\" title=\"Share on Twitter\" aria-label=\"Share on Twitter\" rel=\"noopener nofollow\"><i class=\"icon-twitter\" aria-hidden=\"true\"><\/i><\/a><a href=\"mailto:?subject=Laparoscopic%20Cholecystectomy&body=Check%20this%20out%3A%20https%3A%2F%2Fwww.esrahellas.gr%2Fen%2Fprospect-recommendations%2Flaparoscopic-cholecystectomy%2F\" class=\"icon primary button circle tooltip email\" title=\"Email to a Friend\" aria-label=\"Email to a Friend\" rel=\"nofollow\"><i class=\"icon-envelop\" aria-hidden=\"true\"><\/i><\/a><a href=\"https:\/\/www.linkedin.com\/shareArticle?mini=true&url=https:\/\/www.esrahellas.gr\/en\/prospect-recommendations\/laparoscopic-cholecystectomy\/&title=Laparoscopic%20Cholecystectomy\" onclick=\"window.open(this.href,this.title,'width=500,height=500,top=300px,left=300px'); return false;\" target=\"_blank\" class=\"icon primary button circle tooltip linkedin\" title=\"Share on LinkedIn\" aria-label=\"Share on LinkedIn\" rel=\"noopener nofollow\"><i class=\"icon-linkedin\" aria-hidden=\"true\"><\/i><\/a><\/div><\/div>      <\/div>\n    <\/div>\n\n     \n<style>\n#page-header-83525610 {\n  margin-bottom: 20px;\n}\n<\/style>\n  <\/div>\n    <\/div>\n  \n<div class=\"row align-middle\"  id=\"row-892275144\">\n\n\t<div id=\"col-1872861488\" class=\"col medium-4 small-12 large-4\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\n\t<div class=\"img has-hover x md-x lg-x y md-y lg-y\" id=\"image_2060523624\">\n\t\t\t\t\t\t\t\t<div class=\"img-inner dark\" >\n\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"200\" height=\"66\" src=\"https:\/\/www.esrahellas.gr\/wp-content\/uploads\/2021\/05\/LOGO-PROSPECT-1.jpg\" class=\"attachment-large size-large\" alt=\"\" \/>\t\t\t\t\t\t\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\n<style>\n#image_2060523624 {\n  width: 100%;\n}\n<\/style>\n\t<\/div>\n\t\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\n\n\t<div id=\"col-1719235705\" class=\"col medium-8 small-12 large-8\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\n<h3>Laparoscopic Cholecystectomy- PROSPECT<\/h3>\n<p>Procedure Specific Postoperative Pain Management<\/p>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\n<\/div>\n<div class=\"row\"  id=\"row-1794695884\">\n\n\t<div id=\"col-1821724250\" class=\"col small-12 large-12\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\n<p><strong>GUIDELINES &#8211; RECOMMENDATIONS<\/strong><\/p>\n<p><strong>Procedure Specific Postoperative Pain Management<\/strong><\/p>\n<p><a href=\"http:\/\/www.postoppain.org\/\">www.postoppain.org<\/a><\/p>\n<p><strong>LAPAROSCOPIC CHOLECYSTECTOMY<\/strong><\/p>\n<p><strong>SUMMARY RECOMMENDATIONS<\/strong><\/p>\n<p>Algorithm for the Management of Postoperative Pain following Laparoscopic Cholecystectomy: <a href=\"http:\/\/www.postoppain.org\/image.aspx?imgid=643\">click here<\/a><\/p>\n<p>Not Recommended for Laparoscopic Cholecystectomy: <a href=\"http:\/\/www.postoppain.org\/image.aspx?imgid=641\">click here<\/a><\/p>\n<p>Patient Advice: <a href=\"http:\/\/www.postoppain.org\/extraPage.aspx?epid=83\">click here<\/a><\/p>\n<p>Patient Assessment: <a href=\"http:\/\/www.postoppain.org\/extraPage.aspx?epid=84\">click here<\/a><\/p>\n<p><strong>PROSPECT LAPAROSCOPIC CHOLECYSTECTOMY UPDATE 2006 SUBGROUP<\/strong><\/p>\n<p>For each review, a Subgroup of the PROSPECT Working Group performs an initial evaluation of the evidence and also drafts clinical practice statements and recommendations, which are then discussed by the whole Working Group before a final consensus is reached. The Subgroup may sometimes include a non-Working Group member, to provide additional expertise in the procedure being reviewed. For the laparoscopic cholecystectomy update 2006 review, the Subgroup members were<\/p>\n<ul>\n<li>Mr Rory McCloy<\/li>\n<\/ul>\n<ul>\n<li>Professor Edmund Neugebauer<\/li>\n<\/ul>\n<ul>\n<li>Professor Stephan Schug<\/li>\n<\/ul>\n<p><strong>GRADES OF RECOMMENDATIONS<\/strong><\/p>\n<p>Recommendations are graded according to the overall level of evidence (LoE) on which the recommendations are based, which is determined by the quality and source of evidence: <a href=\"http:\/\/www.postoppain.org\/extraPage.aspx?epid=46\">(Levels of \u0395vidence and Grades of Recommendation in PROSPECT reviews from 2006)<\/a>.<\/p>\n<p>PROSPECT provides clinicians with supporting arguments for and against the use of various interventions in postoperative pain based on published evidence and expert opinion. Clinicians must make judgements based upon the clinical circumstances and local regulations. At all times, local prescribing information for the drugs referred to must be consulted.<\/p>\n<p><strong>SUMMARY RECOMMENDATIONS<\/strong><\/p>\n<p>Pre-, intra- and postoperative interventions have been evaluated for the management of postoperative pain following laparoscopic cholecystectomy. Unless otherwise stated, \u2018pre-operative\u2019 refers to interventions applied before surgical incision, \u2018intra-operative\u2019 refers to interventions applied after incision and before wound closure, \u2018postoperative\u2019 refers to interventions applied at or after wound closure. The following perioperative interventions for laparoscopic cholecystectomy have been reviewed:<\/p>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\n<\/div>\n<div class=\"row row-collapse row-solid\"  id=\"row-1636242223\">\n\n\t<div id=\"col-1763374714\" class=\"col small-12 large-12\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\n<p><strong>PREOPERATIVE RECOMMENDATIONS FOR LAPAROSCOPIC CHOLECYSTECTOMY <\/strong><\/p>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\n\n\t<div id=\"col-676350330\" class=\"col medium-6 small-12 large-6\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\n<p><strong>PREOPERATIVE RECOMMENDED<\/strong><\/p>\n<p><strong><em>SYSTEMIC ANALGESIA<\/em><\/strong><\/p>\n<ul>\n<li><b>Corticosteroids<\/b><br \/>Dexamethasone<br \/>Grade B: analgesic effects<br \/>Grade A: anti-emetic effects<\/li>\n<li><b>COX-2 Selective Inhibitors<\/b><br \/>(Grade B)<\/li>\n<li><strong>Gabapentinoids<\/strong><br \/>Gabapentin (Grade B)<\/li>\n<\/ul>\n<p><em><b>REGIONAL ANALGESIA<\/b><\/em><\/p>\n<ul>\n<li><b>LA Wound Infiltration<\/b><br \/>long &#8211; acting LA wound infiltration (Grade A)<br \/>for reducing wound pain but not shoulder pain<\/li>\n<li><b>Epidural Analgesia\u00a0<\/b><br \/>in high &#8211; risk pulmonary patients (Grade D)<\/li>\n<\/ul>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\n\n\t<div id=\"col-1071330731\" class=\"col medium-6 small-12 large-6\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\n<p><strong>NOT RECOMMENDED<\/strong><\/p>\n<p><strong><em>SYSTEMIC ANALGESIA<\/em><\/strong><\/p>\n<ul>\n<li><b>Alpha-2 Adrenergic Receptor Agonists<\/b><br \/>Clonidine (Grade D)<\/li>\n<li><b>Conventional NSAIDs<\/b><br \/>(Grade B)<\/li>\n<li><b>IV\u00a0\u03a4\u0391<\/b><br \/>(Grade D)<\/li>\n<li><b>NMDA antagonist<\/b><br \/>Dextromethorphan (Grade D)<br \/>Ketamine (Grade D)<br \/>Magnesium (Grade B)<\/li>\n<li><b>Strong Opioids<\/b><br \/>strong opioids (Grade B)<\/li>\n<li><b>Weak opioids<\/b><br \/>Tramadol (Grade B)<\/li>\n<li><b>Paracetamol<\/b>(Grade B)<\/li>\n<\/ul>\n<p><strong><em>REGIONAL ANALGESIA<\/em><\/strong><\/p>\n<ul>\n<li><b>Paravertebral Block<\/b><br \/>(Grade D)<\/li>\n<li><b>Spinal LA + Strong Opioid<\/b><br \/>(Grade D)<\/li>\n<li><b>Epidural Analgesia<\/b><br \/>except in high-risk pulmonary patients\u00a0(Grade D)<\/li>\n<\/ul>\n<p><strong><em>OTHER INTERVENTIONS<\/em><\/strong><\/p>\n<ul>\n<li><b>Oral Carbohydrate<\/b><br \/>(Grade D)<\/li>\n<\/ul>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\n\n\t<div id=\"col-568417757\" class=\"col small-12 large-12\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\n<p><strong>INTRAOPERATIVE RECOMMENDATIONS FOR LAPAROSCOPIC CHOLECYSTECTOMY<\/strong><\/p>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\n\n\t<div id=\"col-1350788590\" class=\"col medium-6 small-12 large-6\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\n<p><strong>INTRAOPERATIVE RECOMMENDED<\/strong><\/p>\n<p><b><i>SYSTEMIC ANALGESIA<\/i><\/b><\/p>\n<ul>\n<li><b>Conventional NSAIDs<\/b><br \/>at end of surgery(Grade D)<\/li>\n<li><b>COX-2 Selective Inhibitors<\/b><br \/>(Grade D)<\/li>\n<li><b>Short Acting Strong Opioids<\/b><br \/>as part of anaesthetic technique (Grade D)<\/li>\n<\/ul>\n<p><strong><em>REGIONAL ANALGESIA<\/em><\/strong><\/p>\n<ul>\n<li><b>LA Wound Infiltration<\/b><br \/>long-acting LA wound infiltration (Grade A)<br \/>for reducing wound pain<br \/>but not shoulder pain<\/li>\n<li><b>IP LA<\/b><br \/>IP LA (Grade A)<br \/>for reducing wound pain<br \/>but not shoulder pain<\/li>\n<li><b>Combined LA Wound Infiltration \/ IP LA<\/b><br \/>(Grade A)<br \/>dose needs toxicity monitoring (Grade D)<\/li>\n<\/ul>\n<p><b><i>ANAESTHETIC TECHNIQUES<\/i><\/b><\/p>\n<ul>\n<li><b>General Anaesthesia (GA)<\/b><\/li>\n<li><b>Combined Epidural \/ GA<\/b><br \/>for high-risk pulmonary patients<br \/>(Grade D)<\/li>\n<\/ul>\n<p><b><i>OPERATIVE TECHNIQUES<\/i><\/b><\/p>\n<ul>\n<li><b>Low &#8211; Pressure CO<sub>2<\/sub><\/b><br \/>(Grade A)<\/li>\n<li><b>Saline Lavage, followed by Suctio<\/b><br \/>(Grade A)<\/li>\n<\/ul>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\n\n\t<div id=\"col-1992517209\" class=\"col medium-6 small-12 large-6\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\n<p><strong>NOT RECOMMENDED<\/strong><\/p>\n<p><b><i>SYSTEMIC ANALGESIA<\/i><\/b><\/p>\n<ul>\n<li><b>NMDA Antagonist<\/b><br \/>Dextromethorphan (Grade D)<br \/>Ketamine infusion (Grade D)<br \/>Magnesium infusion (Grade B)<\/li>\n<li><b>Strong Opioids<\/b><br \/>longer &#8211; acting strong opioids (Grade B)<\/li>\n<\/ul>\n<p><strong><em>REGIONAL ANALGESIA<\/em><\/strong><\/p>\n<ul>\n<li><b>Epinephrine as part of LA solution<\/b><br \/>(Grade B)<\/li>\n<li><b>Intraperitoneal Strong Opioid<\/b><br \/>(Grade D)<\/li>\n<li><b>Interpleural LA<\/b><br \/>(Grade B)<\/li>\n<li><b>Interpleural Strong Opioid<\/b><br \/>(Grade B)<\/li>\n<\/ul>\n<p><b><i>ANAESTHETIC TECHNIQUES<\/i><\/b><\/p>\n<ul>\n<li><b>Combined Epidural \/ GA<\/b><br \/>for routine anaesthesia<br \/>(Grade D)<\/li>\n<\/ul>\n<p><em>OPERATIVE TECHNIQUES<\/em><\/p>\n<ul>\n<li><b>Gasless Laparoscopic Cholecystectomy<\/b><br \/>(Grade A)<\/li>\n<li><b>Humidified and Warmed CO<sub>2<\/sub> <\/b><br \/><b>Pneumoperitoneum<\/b><br \/>(Grade D and A, respectively)<\/li>\n<li><b>N<sub>2<\/sub>O Pneumoperitoneum<\/b><br \/>(Grade D)<\/li>\n<li><b>Helium pneumoperitoneum<\/b>(Grade B)<\/li>\n<li><b>Smaller Total Size of Trocar Incision<\/b><br \/>(Grade D)<\/li>\n<li><b>Radially Expanding Trocars<\/b><br \/>(Grade D)<\/li>\n<li><b>Subhepatic Drain<\/b><br \/>(Grade D)<\/li>\n<li><b>Aspiration of Pneumoperitoneum Gas<\/b><br \/>(Grade D)<\/li>\n<\/ul>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\n\n\t<div id=\"col-1056510794\" class=\"col small-12 large-12\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\n<p><strong>POSTOPERATIVE RECOMMENDATIONS FOR LAPAROSCOPIC CHOLECYSTECTOMY<\/strong><\/p>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\n\n\t<div id=\"col-195050416\" class=\"col medium-6 small-12 large-6\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\n<p><b><em>POSTOPERATIVE RECOMMENDED<\/em><\/b><\/p>\n<p><b><em>Systemic Analgesia<\/em><\/b><\/p>\n<ul>\n<li><b>Conventional NSAIDs<\/b><br \/>(Grade A)<\/li>\n<li><b>COX-2 Selective Inhibitors<\/b><br \/>(Grade A)<\/li>\n<li><b>Strong Opioids<\/b><br \/>for high &#8211; intensity pain<br \/>in addition to other agents (Grade D)<\/li>\n<li><b>Weak Opioids<\/b><br \/>for rescue analgesia<br \/>with medium &#8211; to &#8211; low &#8211; intensity pain<br \/>in addition to other agents<br \/>(Grade D)<\/li>\n<li><b>Paracetamol<\/b><br \/>(Grade A)<\/li>\n<\/ul>\n<p><b><em>Epidural Analgesia<\/em><\/b><\/p>\n<ul>\n<li><b>Epidural Analgesia<\/b><br \/>for high &#8211; risk pulmonary patients (Grade D)<\/li>\n<\/ul>\n<p><b><em>Patient Management<\/em><\/b><\/p>\n<ul>\n<li><b>Early Discharge<\/b><br \/>(Grade D)<\/li>\n<\/ul>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\n\n\t<div id=\"col-8681445\" class=\"col medium-6 small-12 large-6\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\n<p><b><em>NOT RECOMMENDED<\/em><\/b><\/p>\n<p><b><em>Systemic Analgesia<\/em><\/b><\/p>\n<ul>\n<li><b>NMDA Antagonist<\/b><br \/>ketamine (Grade D)<br \/>magnesium (Grade B)<\/li>\n<li><b>Strong Opioids<\/b><br \/>for routine analgesia (Grade B)<\/li>\n<li><b>Weak Opioids<\/b><br \/>for routine analgesia (Grade B)<\/li>\n<\/ul>\n<p><b><i>Regional Analgesia<\/i><\/b><\/p>\n<ul>\n<li><b>PCA IP \u03a4\u0391<\/b><br \/>(Grade D)<\/li>\n<\/ul>\n<p><b><em>Epidural Analgesia<\/em><\/b><\/p>\n<ul>\n<li><b>Epidural Strong Opioid + LA<\/b><br \/>for routine analgesia (Grade D)<\/li>\n<\/ul>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\n<\/div>\n\t<div id=\"gap-1915801397\" class=\"gap-element clearfix\" style=\"display:block; height:auto;\">\n\t\t\n<style>\n#gap-1915801397 {\n  padding-top: 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