Patient-controlled analgesia after laparoscopic and open cholecystectomy

Laparoscopic cholecystectomy (LC) offers advantages over open cholecystectomy (OC) of more rapid patient recovery. The comparative amount of pain that patients must endure after each of these procedures is not clear. We retrospectively analysed the use of patient-controlled analgesia (PCA) of an unselected sample of patients having either LC or OC procedures to quantitate morphine use, as well as pain and sedation scores in the postoperative period. The hospital charts, anaesthetic records and the PCA records of 40 patients having either LC (n = 19) or OC (n = 21) were analysed retrospectively. The use of PCA morphine was standardized and consisted of a loading dose of 5 mg, bolus doses of 1.5 mg and a lockout period of five minutes. By the morning of postoperative day one, OC patients had used 38.0 +/- 11.7 (mean +/- SD) mg compared with 23.7 +/- 15.3 mg in LC patients (P < 0.05). The rates of PCA morphine use in the first two postoperative hours were 4.66 +/- 2.6 mg.hr-1 and 7.04 +/- 2.7 mg.hr-1 for LC and OC patients, respectively (P < 0.05). The rates of morphine use averaged over the day of surgery were 1.28 +/- 0.8 mg.hr-1 and 2.33 +/- 0.8 mg.hr-1 for LC and OC patients (P < 0.05). Despite higher PCA morphine use in OC patients, their pain scores were higher while their sedation scores were comparable. These data suggest that laparoscopic cholecystectomy is associated with less pain than open cholecystectomy in the day after surgery.