Compared with “open” surgical procedures, pain after laparoscopic procedures is considered to be less intense and of shorter duration. Nevertheless, adequate pain control is critical to hasten postoperative recovery and ambulation.
- The origin of pain after most laparoscopic and robotic procedures is predominantly visceral rather than parietal (incision site). In addition, shoulder pain secondary to diaphragmatic irritation is also common and can limit the patient's ability to return to normal activities.
- Optimal pain therapy for patients undergoing laparoscopic and robotic surgery includes the use of multimodal analgesia techniques (nonopioid analgesics should be used when possible).
- Nonsteroidal anti-inflammatory drugs (NSAIDs) or cyclooxygenase (COX)-2 specific inhibitors should be considered as a part of analgesic therapy and combined with acetaminophen because the combination is superior to either drug alone.
- If pain relief remains inadequate, analgesia may be supplemented with opioids.
- Parenteral glucocorticoids (dexamethasone) should also be considered as a part of multimodal analgesia technique because they have been shown to reduce postoperative pain.
- Infiltration of the surgical wound (laparoscopy portals) with local anesthetics can provide excellent analgesia that outlasts the duration of action of the local anesthetic. The transversus abdominis plane block, which involves administration of local anesthetic between the layers of internal oblique and transversus abdominis muscles, may be beneficial in patients undergoing hybrid or laparoscopic-assisted procedures.