Intra-operative Recommendations for Laparoscopic Cholecystectomy

Intra-operative Recommendations for Laparoscopic Cholecystectomy




















INTRA-OPERATIVE RECOMMENDED


NOT RECOMMENDED


SYSTEMIC ANALGESIA


 



  • Conventional NSAIDs

          at end of surgery (Grade D)


 



  • COX-2-selective inhibitors

          (Grade D)


 



  • Short-acting strong opioids

          as part of the anaesthetic technique (Grade D)


 


SYSTEMIC ANALGESIA


 



  • NMDA antagonist

          dextromethorphan (Grade D)


          ketamine infusion (Grade D)


          magnesium infusion (Grade B)


 



  • Strong opioids

          longer-acting strong opioids (Grade B)


 


REGIONAL ANALGESIA



  • LA wound infiltration

long-acting LA wound infiltration (Grade A) for reducing wound pain but not shoulder pain


 



  • IP LA

          IP LA (Grade A) for reducing wound pain but not shoulder pain


 



  • Combined LA wound infiltration/IP LA

          (Grade A; dose needs monitoring for toxicity Grade D)


 


REGIONAL ANALGESIA



  • Epinephrine as part of LA solution

          (Grade B)


 



  • Intraperitoneal strong opioid

          (Grade D)


 



  • Interpleural LA

          (Grade B)


 



  • Interpleural strong opioid

          (Grade B)


 


 


 


ANAESTHETIC TECHNIQUES


 



  • General anaesthesia

 



  • Combined epidural/general anaesthesia

          for high-risk pulmonary patients
(Grade D)


 


 


ANAESTHETIC TECHNIQUES


 



  • Combined epidural/general anaesthesia

          for routine anaesthesia
(Grade D)


 


 


OPERATIVE TECHNIQUES


 



  • Low-pressure CO2

          (Grade A)


 



  • Saline lavage, followed by suction

          (Grade A)


OPERATIVE TECHNIQUES


 



  • Gasless laparoscopic cholecystectomy

          (Grade A)


 



  • Humidified and warmed CO2 pneumoperitoneum

          (Grade D and A, respectively)


 



  • N2O pneumoperitoneum

          (Grade D)


 



  • Helium pneumoperitoneum

          (Grade B)


 



  • Smaller total size of trocar incision

          (Grade D)


 



  • Radially expanding trocars

          (Grade D)


 



  • Subhepatic drain

          (Grade D)


 



  • Aspiration of pneumoperitoneum gas

          (Grade D)