European journal of anaesthesiology
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Laparoscopic cholecystectomy can be associated with significant postoperative pain that is difficult to treat. We aimed to evaluate the available literature and develop updated recommendations for optimal pain management after laparoscopic cholecystectomy. A systematic review was performed using the procedure-specific postoperative pain management (PROSPECT) methodology. ⋯ Three-port laparoscopy, a low-pressure pneumoperitoneum, umbilical port extraction, active aspiration of the pneumoperitoneum and saline irrigation are recommended technical aspects of the operative procedure. The following interventions are not recommended due to limited or no evidence on improved pain scores: single port or mini-port techniques, routine drainage, low flow insufflation, natural orifice transluminal endoscopic surgery (NOTES), infra-umbilical incision, i.v. clonidine, nefopam and regional techniques such as quadratus lumborum block or rectus sheath block. Several interventions provided better pain scores but are not recommended due to risk of side effects: spinal or epidural anaesthesia, gabapentinoids, i.v. lidocaine, i.v. ketamine and i.v. dexmedetomidine.
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Pre-operative screening is a high volume task consuming time and resource. Streamlining patient flow by gathering information in advance reduces costs, optimises resources and diminishes patient burden whilst maintaining safety of care. ⋯ Implementation of PACMAN resulted in a 73.1% reduction in pre-operative in-PCs at our hospital. Given the increasing pressure on healthcare systems globally, we suggest developing further optimisation and integration of smart triage solutions into the pre-operative process.