Pain Assessment and Autonomic Profile in Patients Undergoing Laparoscopic and Open Cholecystectomies: A Study of Respective Effects on Postoperative Pain

Cholecystectomy is very common in hospitals, being performed by open (OC) or laparoscopic (LC) procedures. Surgical and postoperative pain may affect the recovery and its assessment can provide important information about the patient’s clinical condition, avoiding future complications and public health costs. This prospective observational study investigated the differences between OC and LC procedure effects on postoperative pain, by using pain scales and autonomic parameters. We evaluated the pain level and autonomic parameters in 26 adult patients undergoing cholecystectomy. The pain level was measured using the visual analog scale (VAS) and the autonomic parameters were assessed by a 10-min continuous record of the heart rate variability and blood pressure. Data was collected in three moments: before the patient entered the surgery center (M1), on the arrival at the postanesthetic care unit (M2) and three hours after M2 (M3). Data from 26 patients were included in the final analysis: LC (N = 19) or OP (N = 7). Our results suggested that LC is not advantageous over OC, considering pain management. The postoperative pain reported by LC patients was higher at M2, and they also presented an increased sympathetic activation at M3. Unexpectedly, higher pain scores, associated with sympathetic activation, were observed after laparoscopic surgery. Although LC is a minimally invasive procedure, our results showed lower pain levels in OP patients, probably due to epidural anesthesia. Our results highlight the need for reassessment of surgical and postoperative analgesic interventions in LC surgeries for a better recovery and shorter hospitalization of patients.