Clarifying the postsurgical persistent pain after laparoscopic cholecystectomy and the role of intravenous lidocaine.

INTRODUCTION

Persistent abdominal pain after laparoscopic cholecystectomy (PAPLC) incidence is estimated between 3% and 56%. Data concerning PAPLC intensity and its neuropathic characteristics is scarce, and the role of intravenous lidocaine on PAPLC is not clarified.

OBJECTIVES

The authors aim to evaluate PAPLC prevalence, intensity, risk factors, and neuropathic pain (NP) characteristics. Intravenous lidocaine's impact on acute and persistent pain and opioid consumption was explored.

METHODS

In a 3-year follow-up, participants (n = 93) were enquired by telephone after informed consent. Sociodemographic characteristics, intraoperative and postoperative analgesia, acute pain control, preoperative chronic abdominal pain (PCAP), intensity (numeric pain scale score [NPSS]), and Douleur Neuropathique-4 questionnaire were analyzed. A NPSS ≥1 indicated a diagnosis of PAPLC.

RESULTS

A 15.05% prevalence of PAPLC was observed. About 57.1% of PAPLC patients reported moderate-to-severe pain. All PAPLC patients reported NP features. The intraoperative fentanyl dose (P = 0.029), postoperative acute pain in the first 48 hours (P = 0.022), postoperative nausea and vomiting during the first 48 hours (P = 0.019), height (P = 0.016), and PCAP (P = 0.025) were the identified PAPLC risk factors. Dexamethasone administration differed between PAPLC and NPAPLC groups (P = 0.049). Intravenous lidocaine (n = 27) caused a lower need for opioid rescue (P = 0.050) in post-anesthesia care unit (PACU).

CONCLUSION

This study's findings indicate a high PAPLC prevalence and a significant percentage of moderate-to-severe pain. Neuropathic pain characteristics should not be overlooked. The observed PAPLC risk factors follow the evidence. Intravenous lidocaine reduced the need for rescue opioid analgesia in the PACU and nonopioid analgesia in the postoperative period.