Short summary

Elective laparoscopic surgery is a frequent procedure. The patients postoperative pain can be difficult to manage in the recovery room and prolong the hospital stay. The aim of the study is to assess if perioperative consumption of opioids can be optimized, reduce time to discharge, and enhance initial recovery using NOL monitor in elective laparoscopic cholecystectomy patients.

Rationale

Elective laparoscopic surgery is often an ambulatory procedure. Many patients experience postoperative pain, which is difficult to threat and not necessarily related to surgery but due to CO2 insufflation in the abdomen (pneumoperitoneum) and irritation of the diaphragm (referred pain). Together with nausea/vomiting these are limiting factors for discharge. This patient group is difficult to manage in the recovery room (RR) and therefore spend a relatively long time at hospital from the OR to discharge. Furthermore, this group experiences discomfort after discharge although this is not quantified sufficiently. The main purpose of this study is to determine whether a nociception level monitor (NOL) reduce postoperative opioids consumption, primarily in the RR, but also during the first week of recovery. Secondarily, we want to evaluate whether the use of NOL guided pain medication during surgery reduce the perceived pain experience (VAS-score, Visual Analog Scale) and decrease the time to discharge. Finally, we want to study whether the use of NOL during surgery has a long-term effect on recovery by using the QoR40 (Questionnaire of Recovery 40, a tool developed to assess recovery after surgery), as nociceptive response during surgery may relate to postoperative complications.

Description of the cohort

American Society of Anesthesiologists (ASA) class I-III patients aged 18 years +, non-pregnant, must read and understand Danish, scheduled for ambulatory elective laparoscopic cholecystectomy.

Data and biological material

Data from patient journal Questionnaire data

Publications associated with the project

Behzad Nazemroaya, et al, Comparison of Intraperitoneal Versus Intravenous Dexamethasone on Postoperative Pain, Nausea, and Vomiting After Laparoscopic Cholecystectomy, Anesth Pain Med. 2022 Apr; 12(2): e122203.

K. Jensen, 1 H. Kehlet, 2 C. M. Lund 3, Post-operative recovery profile after laparoscopic cholecystectomy: a prospective, observational study of a multimodal anaesthetic regime, Acta Anaesthesiologica Scandinavia, Volume51, Issue4, April 2007, Pages 464-471

Wei Xiong, 1 Ming Li, 2 Ming Wang, 2 Shu Zhang, 2 and Qin Yang, The Safety of Laparoscopic Cholecystectomy in the Day Surgery Unit Comparing with That in the Inpatient Unit: A Systematic Review and Meta-Analysis, Review, Biomed Res Int. 2020 Apr 28;2020:1924134. doi: 10.1155/2020/1924134. eCollection 2020.

Anudeep Jafra and Sukanya Mitra, Pain relief after ambulatory surgery: Progress over the last decade, Saudi J Anaesth. 2018 Oct-Dec; 12(4): 618-625.

H Kehlet 1 , Multimodal approach to control postoperative pathophysiology and rehabilitation, Review Br J Anaesth. 1997 May;78(5):606-17. doi: 10.1093/bja/78.5.606.

Henrik Kehlet 1 , Postoperative pain, analgesia, and recovery-bedfellows that cannot be ignored, Review, Pain. 2018 Sep;159 Suppl 1:S11-S16. doi: 10.1097/j.pain.0000000000001243.

B F Gornall 1, P S Myles, C L Smith, J A Burke, K Leslie, M J Pereira, J E Bost, K B Kluivers, U G Nilsson, Y Tanaka, A Forbes, Measurement of quality of recovery using the QoR-40: a quantitative systematic review, Br J Anaesth. 2013 Aug;111(2):161-9. doi: 10.1093/bja/aet014. Epub 2013 Mar 6.

Hiroki Ogata 1, Shiroh Nakamoto 1, Hiroki Miyawaki 1, Ryusuke Ueki 1, Nobutaka Kariya 1, Tsuneo Tatara 1, Munetaka Hirose, Association between intraoperative nociception and postoperative complications in patients undergoing laparoscopic gastrointestinal surgery, J Clin Monit Comput. 2020 Jun;34(3):575-581. doi: 10.1007/s10877-019-00347-3. Epub 2019 Jul 1.

Ogata, Hiroki; Matsuki, Yuka; Okamoto, Takuma; Ueki, Ryusuke; Kariya, Nobutaka; Tatara, Tsuneo; Shigemi, Kenji; Hirose, Munetaka, Intra-operative nociceptive responses and postoperative major complications after gastrointestinal surgery under general anaesthesia, A prospective cohort study, European Journal of Anaesthesiology: December 2021 - Volume 38 - Issue 12 - p 1215-1222, doi: 10.1097/EJA.0000000000001505