Laparoskopik Kolesistektomi ve Postoperatif Ağrı
Synopsis
Laparoscopic cholecystectomy is frequently preferred in the surgical treatment of gallbladder diseases compared to open cholecystectomy due to distinct advantages such as reduced postoperative pain, early discharge (24-48 hours), faster resumption of oral intake, and lower cost. The surgical procedure is performed by creating pneumoperitoneum via CO2 insufflation into the peritoneal cavity using Hasson or Veress needle techniques until an intra-abdominal pressure of 10-15 mmHg is reached. While major intraoperative complications such as venous gas embolism, cardiopulmonary arrhythmias, subcutaneous emphysema, hypothermia, and positioning-related nerve injuries may occur during surgery, postoperative peritonitis, surgical wound infection, nausea, vomiting, and severe pain can develop. Abdominal pain occurs in the early postoperative period due to abdominal wall incisions, trocar insertion sites, tissue ischemia, and CO2 gas irritation of the diaphragm and phrenic nerve, whereas referred shoulder pain is observed in the late period. Postoperative pain, classified by duration, origin region, and mechanism, is perceived through four physiological stages: transduction, transmission, modulation, and perception. Single- and multi-dimensional measurement methods, including the Visual Analogue Scale (VAS), are utilized for pain intensity assessment. In postoperative pain management, multimodal treatment approaches encompassing systemic, regional, patient-controlled analgesia (PCA), and non-pharmacological techniques are adopted to minimize analgesic requirements and drug side effects, with NSAIDs and opioid analgesics being widely used in therapy.
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