The Role of Surgical Techniques in Reducing Postoperative Pain in Abdominal Surgery: Evidence From the PROSPECT Systematic Reviews.

Abstract

Inadequate postoperative pain control remains a significant concern as patients continue to experience moderate-to-severe pain after surgery. The influence of surgical techniques has not previously been systematically reviewed. In this clinical review, data regarding the influence of surgical techniques on postoperative pain after abdominal surgery were extracted and collated from seven published PROSPECT recommendations. The effects of surgical incision and its technique, laparoscopic technique, and local anesthetic infiltration were critically reviewed. The surgical techniques that are recommended and those that are not recommended for the seven procedures are presented. In general, very few studies have assessed the influence of surgical techniques on postoperative pain management. PROSPECT recommends transverse over vertical incision for open colorectal surgery, and cutting diathermy over use of scalpel in appendicectomy, inguinal hernia, and open colorectal surgeries. For laparoscopic cholecystectomy, a three-port (vs. four-port) technique and low-pressure pneumoperitoneum (< 12 mmHg) are recommended to reduce the risk of postoperative shoulder pain. This clinical review demonstrates the important role of surgeons in achieving clinically significant benefits by using appropriate incision techniques, laparoscopic methods, and local anesthetic infiltration. Effective pain relief after surgery can improve recovery and reduce the risk of chronic pain. Our study emphasizes the need for future research in this field.