Types and causes of chronic pain after laparoscopic operations
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20214301Keywords:
Laparoscopy, Surgery, Abdominal surgery, Hysterectomy, Cholecystectomy, Nephrectomy, Pain, Chronic pain, ComplicationAbstract
Laparoscopy has been introduced as a minimally invasive approach that has been developed to achieve the intended outcomes by open surgeries but with less frequent body injuries and complications. However, evidence indicates that the reported favourable outcomes are mainly based on retrospective data and using historical controls and only a few prospective investigations and clinical trials were published. Furthermore, studies have also demonstrated that following laparoscopy, severe pain can develop similar to or equal to the pain reported during open surgeries that develop within the earliest hours due to the significant tissue trauma introduced by laparoscopy. The present literature review discussed the different causes and types of chronic pain following laparoscopy. We also shed more light on the potential mechanisms and pathophysiology that attributes to the development of pain following laparoscopy. Many studies have indicated the development of chronic pain after 3, 6 and 12 months after hysterectomy, cholecystectomy, nephrectomy, colorectal surgeries and other abdominal surgeries. The development of postoperative main might be attributed to the tissue or nerve injury and associated inflammatory status that can also aid to the development of pain in such settings. Evidence also shows that the incidental pain following laparoscopy is similar or superior to that following open surgeries. Therefore, further interventional approaches are needed to enhance the outcomes.
References
Eltabbakh GH, Shamonki MI, Moody JM, Garafano LL. Laparoscopy as the primary modality for the treatment of women with endometrial carcinoma. Cancer. 2001;91(2):378-87.
D'Alonzo RC, Gan TJ, Moul JW, Albala DM, Polascik TJ, Robertson CN, et al. A retrospective comparison of anesthetic management of robot-assisted laparoscopic radical prostatectomy versus radical retropubic prostatectomy. J Clin Anesth. 2009;21(5):322-8.
Kornblith AB, Huang HQ, Walker JL, Spirtos NM, Rotmensch J, Cella D. Quality of life of patients with endometrial cancer undergoing laparoscopic international federation of gynecology and obstetrics staging compared with laparotomy: a gynecologic oncology group study. J Clin Oncol. 2009;27(32):5337-42.
Ekstein P, Szold A, Sagie B, Werbin N, Klausner JM, Weinbroum AA. Laparoscopic surgery may be associated with severe pain and high analgesia requirements in the immediate postoperative period. Ann Surg. 2006;243(1):41-6.
Sjövall S, Kokki M, Kokki H. Laparoscopic surgery: a narrative review of pharmacotherapy in pain management. Drugs. 2015;75(16):1867-89.
Fletcher D, Stamer UM, Pogatzki-Zahn E, Zaslansky R, Tanase NV, Perruchoud C, et al. Chronic postsurgical pain in Europe: An observational study. Eur J Anaesthesiol. 2015;32(10):725-34.
Bisgaard T, Støckel M, Klarskov B, Kehlet H, Rosenberg J. Prospective analysis of convalescence and early pain after uncomplicated laparoscopic fundoplication. Br J Surg. 2004;91(11):1473-8.
Bisgaard T, Rosenberg J, Kehlet H. From acute to chronic pain after laparoscopic cholecystectomy: a prospective follow-up analysis. Scand J Gastroenterol. 2005;40(11):1358-64.
Aspinen S, Harju J, Juvonen P, Kokki H, Remes V, Scheinin T, et al. A prospective, randomized multicenter study comparing conventional laparoscopic cholecystectomy versus minilaparotomy cholecystectomy with ultrasonic dissection as day surgery procedure-1-year outcome. Scand J Gastroenterol. 2014;49(11):1336-42.
Blichfeldt-Eckhardt MR, Ording H, Andersen C, Licht PB, Toft P. Early visceral pain predicts chronic pain after laparoscopic cholecystectomy. Pain. 2014;155(11):2400-7.
Pokkinen SM, Nieminen K, Yli-Hankala A, Kalliomäki ML. Persistent posthysterectomy pain: a prospective, observational study. Eur J Anaesthesiol. 2015;32(10):718-24.
Theunissen M, Peters ML, Schepers J, Maas JWM, Tournois F, Suijlekom HAV, et al. Recovery 3 and 12 months after hysterectomy: epidemiology and predictors of chronic pain, physical functioning, and global surgical recovery. Medicine (Baltimore). 2016;95(26):3980.
Holtzman S, Clarke HA, McCluskey SA, Turcotte K, Grant D, Katz J. Acute and chronic postsurgical pain after living liver donation: Incidence and predictors. Int Liver Transplant Soc. 2014;20(11):1336-46.
Oh J, Pagé MG, Zhong T, McCluskey S, Srinivas C, O'Neill AC, et al. Chronic postsurgical pain outcomes in breast reconstruction patients receiving perioperative transversus abdominis plane catheters at the donor site: a prospective COHORT follow-up study. Pain Pract. 2017;17(8):999-1007.
Joris JL, Georges MJ, Medjahed K, Ledoux D, Damilot G, Ramquet CC, et al. Prevalence, characteristics and risk factors of chronic postsurgical pain after laparoscopic colorectal surgery: retrospective analysis. Eur J Anaesthesiol. 2015;32(10):712-7.
Jeppesen M, Tolstrup MB, Gögenur I. chronic pain, quality of life, and functional impairment after surgery due to small bowel obstruction. World J Surg. 2016;40(9):2091-7.
Sevonius D, Montgomery A, Smedberg S, Sandblom G. Chronic groin pain, discomfort and physical disability after recurrent groin hernia repair: impact of anterior and posterior mesh repair. J Hernia Abdominal Wall Surg. 2016;20(1):43-53.
Alper I, Yüksel E. Comparison of acute and chronic pain after open nephrectomy versus laparoscopic nephrectomy: a prospective clinical trial. Medicine (Baltimore). 2016;95(16):3433.
Bisgaard T, Klarskov B, Rosenberg J, Kehlet H. Characteristics and prediction of early pain after laparoscopic cholecystectomy. Pain. 2001;90(3):261-9.
Demco L. Effect of heating and humidifying gas on patients undergoing awake laparoscopy. J Am Assoc Gynecol Laparoscop. 2001;8(2):247-51.
Koivusalo AM, Kellokumpu I, Scheinin M, Tikkanen I, Halme L, Lindgren L. Randomized comparison of the neuroendocrine response to laparoscopic cholecystectomy using either conventional or abdominal wall lift techniques. Br J Surg. 1996;83(11):1532-6.
Aitola P, Airo I, Kaukinen S, Ylitalo P. Comparison of N2O and CO2 pneumoperitoneums during laparoscopic cholecystectomy with special reference to postoperative pain. Surg Laparosc Endosc. 1998;8(2):140-4.
Sandhu T, Yamada S, Ariyakachon V, Chakrabandhu T, Chongruksut W, Ko-Iam W. Low-pressure pneumoperitoneum versus standard pneumoperitoneum in laparoscopic cholecystectomy, a prospective randomized clinical trial. Surg Endosc. 2009;23(5):1044-7.
Mouton WG, Bessell JR, Otten KT, Maddern GJ. Pain after laparoscopy. Surg Endosc. 1999;13(5):445-8.
Tsai HW, Chen YJ, Ho CM, Hseu S, Chao K, Tsai S, et al. Maneuvers to decrease laparoscopy-induced shoulder and upper abdominal pain: a randomized controlled study. Arc Surg. 2011;146(12):1360-6.
Jakeways MS, Mitchell V, Hashim IA, Chadwick SJ, Shenkin A, Green CJ, et al. Metabolic and inflammatory responses after open or laparoscopic cholecystectomy. Br J Surg. 1994;81(1):127-31.
Kokki M, Broms S, Eskelinen M, Neuvonen PJ, Halonen T, Kokki H. The analgesic concentration of oxycodone with co-administration of paracetamol a dose-finding study in adult patients undergoing laparoscopic cholecystectomy. Basic Clinic Pharmacol Toxicol. 2012;111(6):391-5.
Donatsky AM, Bjerrum F, Gögenur I. Surgical techniques to minimize shoulder pain after laparoscopic cholecystectomy. A systematic review. Surg Endosc. 2013;27(7):2275-82.
Savaris RF, Chicar LL, Cristovam RS, Moraes GS, Miguel OA. Does bupivacaine in laparoscopic ports reduce postsurgery pain in tubal ligation by electrocoagulation? A randomized controlled trial. Contraception. 2010;81(6):542-6.
Lee E, Teeple M, Bagrodia N, Hannallah J, Yazzie NP, Adamas-Rappaport WJ. Postoperative pain assessment and analgesic administration in Native American patients undergoing laparoscopic cholecystectomy. JAMA Surg. 2013;148(1):91-3.
Brennan TJ. Pathophysiology of postoperative pain. Pain. 2011;152(3):33.
Harju J, Juvonen P, Kokki H, Remes V, Scheinin T, Eskelinen M. Minilaparotomy cholecystectomy with ultrasonic dissection versus conventional laparoscopic cholecystectomy: a randomized multicenter study. Scand J Gastroenterol. 2013;48(11):1317-23.
Kerimoglu OS, Yilmaz SA, Pekin A, İncesu F, Dogan NU, İlhan TT, et al. Effect of drainage on postoperative pain after laparoscopic ovarian cystectomy. J Obstetr Gynaecol. 2015;35(3):287-9.
Xu M, Tao YL. Drainage versus no drainage after laparoscopic cholecystectomy for acute cholecystitis: a meta-analysis. Am Surg. 2019;85(1):86-91.
Joris J, Thiry E, Paris P, Weerts J, Lamy M. Pain after laparoscopic cholecystectomy: characteristics and effect of intraperitoneal bupivacaine. Anesth Analg. 1995;81(2):379-84.
Sarac AM, Aktan AO, Baykan N, Yegen C, Yalin R. The effect and timing of local anesthesia in laparoscopic cholecystectomy. Surg Laparosc Endosc. 1996;6(5):362-6.
McMahon AJ, Russell IT, Ramsay G, Sunderland G, Baxter JN, Anderson JR, et al. Laparoscopic and minilaparotomy cholecystectomy: a randomized trial comparing postoperative pain and pulmonary function. Surgery. 1994;115(5):533-9.
