Difficult laparoscopic cholecystectomy and postoperative requirement of analgesics: An observational study

Abstract

Context: Despite many advances in laparoscopic cholecystectomy (LC), postoperative pain is still a problem. Difficult and prolonged procedures may cause more postoperative pain. Operative difficulty scores in LC and their correlation with the postoperative visual analog scale (VAS) pain scores and postoperative analgesic requirements in these patients have not been studied before. Aim: The aim of this study is to evaluate the requirement of postoperative analgesics in patients with different grades of intraoperative difficulties in elective LC. Settings and Designs: This was an observational study conducted at two peripheral hospitals in Kashmir. Materials and Methods: A total of 322 patients were scheduled for LC. Nassar scale (grades 1–5) was used to grade the operative difficulty. Postoperatively, intramuscular injection of diclofenac sodium 50 mg BD was used for analgesia. The data recorded were duration of surgery, postoperative VAS score (0–10), and requirement of additional postoperative rescue analgesic with reference to Nassar scale. Statistical Analysis: Chi-square test/one-way ANOVA was used as a test of significance. Results: Sixteen patients required conversion to open cholecystectomy and were excluded from the study. The final study group comprised of a total of 306 patients (112 males and 194 females). The age of the patients ranged between 16 and 60 years with a body mass index of <30. Nassar intraoperative difficulty grades of I, II, III, and IV were observed in 68.3%, 18.6%, 9.80%, and 3.26% of the patients, respectively. The mean operative time was longer with higher Nassar intraoperative grade (P < 0.05). The mean postoperative VAS was persistently higher in patients with Nassar grades of III and IV at different points of time but was statistically significant only at 3 h postoperatively (P < 0.05). Postoperative rescue analgesic was required by 0.95%, 7.01%, 50%, and 70% of patients with Nassar grade of I, II, III, and IV, respectively. Conclusions: With increasing level of difficulty in LC, there is increased postoperative pain and requirement for additional analgesia.