Evidence-based postoperative pain management after laparoscopic colorectal surgery

• Published in: Colorectal disease 2013-02, Vol.15 (2), p.146-155
• Main Authors: Joshi, G. P., Bonnet, F., Kehlet, H.
• Format: Article
• Language: English
• Subjects: analgesia; Analgesics - administration & dosage; Analgesics - adverse effects; Colorectal Surgery - instrumentation; Colorectal Surgery - methods; Evidence-Based Medicine; Humans; Laparoscopic colorectal surgery; Laparoscopy; pain; pain, analgesia; Pain, Postoperative - drug therapy; Randomized Controlled Trials as Topic; systematic review
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/j.1463-1318.2012.03062.x

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.