From the Guidelines
The best approach for pain control in biliary colic is to use ultrasound (US) as the first choice of investigation to diagnose or exclude gallstones, and then manage the pain accordingly.
Key Points
- US is the initial test of choice for imaging patients with suspected acute cholecystitis due to its high accuracy in detecting gallstones, with a reported accuracy of 96% 1.
- Pain management should be tailored to the individual patient's needs, taking into account the severity of the pain and the patient's medical history.
- Cholecystectomy may be considered for patients with symptomatic gallstones, especially if they have a high risk of complications or if the pain is severe and recurrent.
- Laparoscopic cholecystectomy is a viable option for patients who require surgery, but the clinician and patient should determine the experience of the surgeon before choosing this route 1.
Diagnosis and Treatment
- Ultrasonography is the preferred diagnostic test for gallstones, as it is non-invasive and highly accurate 1.
- Oral cholecystography or plain roentgenography may also be used to diagnose gallstones, but US is generally the first choice 1.
- Cholecystokinin-cholescintigraphy (CCK-CS) may be used in certain cases, such as when the diagnosis is unclear or when the patient has atypical symptoms 1.
Important Considerations
- Patient selection is crucial when considering CCK-CS, as it should only be performed in patients who meet specific criteria, such as those with functional biliary pain and a normal gallbladder ultrasound 1.
- Surgical experience is an important factor to consider when choosing a surgeon for laparoscopic cholecystectomy, as the complication rate may be higher for less experienced surgeons 1.
From the Research
Pain Control in Biliary Colic
- The best approach for pain control in biliary colic involves the use of nonsteroidal anti-inflammatory drugs (NSAIDs) as the first-line treatment 2, 3, 4.
- NSAIDs have been shown to be effective in controlling pain and reducing the risk of complications in patients with biliary colic 2, 3, 4.
- Compared to other analgesics, NSAIDs have been found to be more efficacious in controlling pain and reducing the need for rescue analgesia 2, 3, 4.
- The use of NSAIDs has also been associated with a lower risk of progression to acute cholecystitis 2, 4.
Alternative Treatment Options
- Opioids may also be used for pain control in biliary colic, but they are not as effective as NSAIDs in reducing the risk of complications 2, 5.
- Paracetamol combined with low-dose morphine may be an effective alternative for pain management in patients with biliary colic 5.
- Other treatment options, such as spasmolytics, may not be as effective as NSAIDs in controlling pain 2.
Management of Biliary Colic
- The management of acute biliary colic mainly involves pain control with NSAIDs or narcotic pain relievers 6.
- Ultrasonography is the best initial imaging study for most patients, and additional imaging studies may be indicated 6.
- Laparoscopic cholecystectomy remains the surgical choice for symptomatic and complicated gallstones, with a shorter hospital stay and shorter convalescence period than open cholecystectomy 6.