Pre-operative Recommendations for Laparoscopic Cholecystectomy

Pre-operative Recommendations for Laparoscopic Cholecystectomy
















PRE-OPERATIVE RECOMMENDED


NOT RECOMMENDED


SYSTEMIC ANALGESIA


 



  • Corticosteroid

          dexamethasone (Grade B for analgesic effects; Grade A for anti-emetic effects)


 



  • COX-2-selective inhibitors

          (Grade B)


 


 



  • Gabapentinoids

          gabapentin (Grade B)


 


 


SYSTEMIC ANALGESIA


 



  • Alpha-2-adrenergic receptor agonists

          clonidine (Grade D)


 



  • Conventional NSAIDs

          (Grade B)


 



  • IV LA

          (Grade D)


 



  • NMDA antagonist

          dextromethorphan (Grade D)


          ketamine (Grade D)


          magnesium (Grade B)


 



  • Strong opioids

          strong opioids (Grade B)


 



  • Weak opioids

          tramadol (Grade B)


 



  • Paracetamol

          (Grade B)


 


REGIONAL ANALGESIA


 



  • LA wound infiltration

          long-acting LA wound infiltration (Grade A)  for reducing wound pain but not shoulder pain


 



  • Epidural analgesia

          in high-risk pulmonary patients (Grade D)


 


 


REGIONAL ANALGESIA


 



  • Paravertebral block

          (Grade D)


 



  • Spinal LA + strong opioid

          (Grade D)


 



  • Epidural analgesia

          except in high-risk pulmonary patients (Grade D)


 


 


OTHER INTERVENTIONS


 



  • Oral carbohydrate

          (Grade D)