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Postoperative Pain

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Robotic Surgery for Abdominal Wall Hernia Repair

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Abstract

Minimally invasive surgery, including robotic and laparoscopic surgery, has become the standard of care for treatment of most intra-abdominal conditions. The main focus currently is on the operative technique but postoperative patient care is an essential part of the process to make this technique safe and successful.

The etiology of postlaparoscopic pain can be classified into at least three categories: visceral, incisional, and shoulder tip pain. Low-pressure pneumoperitoneum with deep neuromuscular block is worth considering for patients undergoing laparoscopic surgery. Patients reported a significantly lower intensity of postoperative abdominal pain.

Multimodal analgesia has shown improved recovery, less nausea and vomiting, and fewer opiate side effects; these can culminate into shorter hospital stays, less morbidity, and increased patient satisfaction.

Regional anesthesia given during robotic surgery significantly decreases both short-term postoperative opioid use and pain experienced by patients Two procedures have an important role in the postoperative analgesia of patients undergoing robotic surgery: TAP block and quadratus lumborum block. Quality improvement requires implementation of tools to improve patient and financial outcomes. These abdominal wall blocks may be an efficient, cost-effective method for improving laparoscopic results.

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Author information

Authors and Affiliations

  1. Medical Services of Anesthesia (SMA)/Sirio-libanês Hospital, São Paulo, Brazil

    Pedro Paulo Kimachi & Elaine Gomes Martins

  2. Coordinator of the Postgraduate Course of the Regional Anesthesia in the Teaching and Research Sirio-libanês Institute, São Paulo, Brazil

    Pedro Paulo Kimachi

  3. Coordinator of the Ultrasound Point-of-Care Course in the Teaching and Research Sirio-libanês Institute, São Paulo, Brazil

    Pedro Paulo Kimachi

Authors
  1. Pedro Paulo Kimachi
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  2. Elaine Gomes Martins
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Corresponding author

Correspondence to Pedro Paulo Kimachi .

Editor information

Editors and Affiliations

  1. Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil

    Ricardo Z. Abdalla

  2. Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil

    Thiago Nogueira Costa

Glossary

IAP

Intra-abdominal pressure is the steady-state pressure concealed within the abdominal cavity.

NMDA

The NDMA antagonist is a receptor for the excitatory neurotransmitter glutamate, which is released with noxious peripheral stimuli. Therefore, NMDA antagonists may play a role in these areas of pain management. There are several NMDA receptor antagonists available, including ketamine, methadone, and memantine.

NSAIDS 

Nonsteroidal anti-inflammatory drugs block the Cox enzymes and reduce prostaglandins throughout the body. As a consequence, ongoing inflammation, pain, and fever are reduced.

QLB

The quadratus lumborum block is a postoperative analgesic method used following abdominal surgery.

Shoulder tip pain

Pain in the shoulder tip and rib cage. This is due to small amounts of gas remaining under the diaphragm postoperatively.

TAP

The transversus abdominis plane is the plane between the internal oblique and transversus abdominis muscles. There are spinal nerve branches in this area.

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Kimachi, P.P., Gomes Martins, E. (2018). Postoperative Pain. In: Abdalla, R., Costa, T. (eds) Robotic Surgery for Abdominal Wall Hernia Repair. Springer, Cham. https://doi.org/10.1007/978-3-319-55527-0_8

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  • DOI: https://doi.org/10.1007/978-3-319-55527-0_8

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-55526-3

  • Online ISBN: 978-3-319-55527-0

  • eBook Packages: MedicineMedicine (R0)

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