Fibrin Sealants Effectively Relieve Pain Following Laparoscopic Cholecystectomy

Implanting fibrin sealant with sustained-release ropivacaine in the gallbladder bed safely and effectively relieves pain after laparoscopic cholecystectomy (LC), according to a new study.

Researchers at Capital Medical University (Beijing, China) studied 60 patients who underwent LC and were randomly divided into three equal groups: group A, who underwent implantation of fibrin sealant in the gallbladder bed; group B, who underwent implantation of fibrin sealant carrying ropivacaine in the gallbladder bed; and group C, who were irrigated with normal saline in the gallbladder bed. Patients with previous major upper abdominal surgeries, choledocholithiasis, acute cholecystitis, or conversion to open cholecystectomy were excluded from the study. The researchers evaluated postoperative pain, and pain relief was assessed by visual analog scale (VAS) scoring.

The results showed that 81.7% of patients had visceral pain, 50% experienced parietal pain, and 26.7% reported shoulder pain following LC. Visceral pain was significantly less in group B patients than in the other groups, and only one patient within group B experienced shoulder pain. The mean VAS score in group B patients was also lower than that of the patients in the other groups. The study was published in the December 14, 2009, issue of World Journal of Gastroenterology.

"The VAS score for the patients with fibrin sealant alone implanted in the gallbladder bed was less than that of the control group, although the differences were not statistically significant,” concluded lead author Jian-Zhu Fu, M.D., and colleagues of the department of general surgery. "This suggests that the gallbladder bed with implanted fibrin sealant alone may lead to a slight relief in postoperative pain.”

The incidence of pain after laparoscopy is attributed to the carbon dioxide gas (CO2) used to induce pneumoperitoneum. CO2 remains in the peritoneal cavity for several days after surgery, causing stretching of the phrenic nerve endings, local hypothermia, and diaphragmatic irritation via carbonic acid. The pain can be divided into three components, namely, visceral, parietal, and shoulder pain, with different intensities and time courses. LC is mainly associated with visceral pain, which may refer to the shoulder in 35% to 60% of cases. Various treatments have been proposed to make LC as pain-free as possible; since fibrin sealant has been used to release medicines slowly at a fixed site as an adjunct to surgical procedures and to control diffuse slow bleeding over large surfaces, it is reasonable to assume it could also serve in LC.

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