Background: Immediate laparoscopic cholecystectomy is the accepted standard for the treatment of acute\ncholecystitis. The aim of the present study was to evaluate the feasibility of a standardized approach with tailored\ncare maps for pre- and postoperative care by comparing pain, nausea and patient satisfaction after elective and\nemergent laparoscopic cholecystectomy.\nMethods: From January 2014 until April 2015, data on pain and nausea management were prospectively recorded\nfor all elective and emergency procedures in the department of visceral surgery. This prospective observational\nstudy compared consecutive laparoscopic elective vs. emergency cholecystectomies. Visual analogue scales (VAS)\nwere used to measure pain, nausea, and satisfaction from recovery room until 96 hours postoperatively.\nResults: Final analysis included 168 (79%) elective cholecystectomies and 44 (21%) emergent procedures.\nDemographics (Age, gender, BMI and ASA-scores) were comparable between the 2 groups. In the emergency\ngroup, patients did not receive anxiolytic medication (0% vs.13%, p = 0.009) and less postoperative nausea and\nvomiting (PONV) prophylaxis (77% vs. 97% p = <0.001). Perioperative pain management was similar in terms of\nopioid consumption (median amount of fentanyl 450ug [IQR 350-500] vs. 450ug [375-550], p = 0.456) and wound\ninfiltration rates (24% vs. 25%, p = 0.799). Postoperative consumption of paracetamol, metamizole and opiod\nmedications were similar between the 2 groups. VAS scores for pain (p = 0.191) and nausea (p = 0.392) were low\nfor both groups. Patient satisfaction was equally high in both clinical settings (VAS 8.5 �± 1.1 vs. 8.6 �± 1.1, p = 0.68).\nConclusions: A standardized pathway allows equally successful control of pain and nausea after both elective and\nemergency laparoscopic cholecystectomy.\nThis study was retrospectively registered by March 01, 2016 in the following trial register: www.researchregistry.com\n(UIN research registry 993)
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