Comparing Postoperative Pain After Laparoscopic Cholecystectomy.

who compared postoperative pain after traditional and single‑incision laparoscopic cholecystectomy (SILC), it was showed that SILC resulted in a slightly less immediate postoperative pain, but pain scores at 24 hours, 7 days, and 1–6 months after surgery were not different between the two operations. Many things of this study were well done. The authors used a double‑blinded, randomized, and controlled design. They chose a well‑validated endpoint of postoperative pain assessment: Visual analog scale (VAS). They had a large number of patients with a consistent operation and attempted to control most of the known factors affecting postoperative pain following cholecystectomy, such as age, gender, body mass index, type of surgery, and surgical complications. Furthermore, they openly discussed the limitations of their work. All of these are strengths in the study design. We can learn from their example. In our view, however, there were several important issues in this study that were not well addressed. First, the study subjects were patients with symptomatic gallstones or polyps documented by imaging. Actually, chronic abdominal pain is highly prevalent among these patients and can often cause psychological disorders, such as neuroticism, depression, and anxiety. It was unclear whether preoperative pain intensity, duration of pain, and pain‑related psychological morbidities were comparable between groups. It has been shown that a high preoperative gastrointestinal quality of life index score, episodic pain, and duration of pain of 1 year or less are associated with the postoperative absence of pain in patients undergoing cholecystectomy for uncomplicated symptomatic cholecystolithiasis. Furthermore, preoperative neuroticism, depression, and anxiety can significantly affect the postoperative pain severity determined by VAS. Second, the readers were not provided with detail of anesthesia and perioperative managements. The available literature indicates that preoperative single‑dose dexamethasone, wound infiltration of local anesthetic, subhepatic infiltration of local anesthetic, and combined wound and intraperitoneal use of local anesthetic can significantly reduce pain scores after laparoscopic cholecystectomy. For laparoscopic cholecystectomy, spinal anesthesia is associated with less early postoperative pain and lower incidence of postoperative complications than general anesthesia. [6] Moreover, we were very interested in knowing whether dose of opioid and analgesic drugs used during anesthesia were comparable between groups. When early postoperative pain between groups is compared, standardization of intraoperative use of opioid and analgesic drugs should be a crucial component of study design. For example, in patients scheduled for cholecystectomy under general anesthesia, intraoperative low‑dose ketamine infusion provides good postoperative analgesia and reduces …