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)