From the Guidelines
For cholecystitis pain management, opioids such as fentanyl (12 μg/kg with a background continuous infusion of 1 to 2 mL/h and a 1 mL bolus with a 15-min lockout) or oxycodone (0.7 mg/kg with a background continuous infusion of 1 to 2 mL/h and a 1 mL bolus with a 15-min lockout) are effective options for moderate-to-severe pain unresponsive to other medications, as recommended by recent guidelines 1. When considering pain management for cholecystitis, it's essential to weigh the benefits and risks of different analgesics.
- Opioids are strong and fast-acting analgesics that can be effective for severe pain, but they also carry the risk of side effects and dependency, as highlighted in the context of the worldwide opioid crisis 1.
- The choice of opioid should be based on the individual patient's needs and medical history, with options including fentanyl, oxycodone, and sufentanil.
- Fentanyl and oxycodone have been compared in studies, with oxycodone providing slightly better postoperative pain relief and less sedation, but also more side effects than fentanyl 1.
- The use of sublingual sufentanil tablets has also been explored, offering a non-invasive option with a high therapeutic index and no clinically relevant active metabolites 1.
- In cases where patient-controlled analgesia (PCA) is not available, transdermal fentanyl patches may be used as an alternative, providing a constant concentration without evidence of respiratory depression 1.
- It's crucial to regularly assess sedation levels, respiratory status, and potential adverse events in patients on systemic treatment with opioids, as recommended by guidelines 1.
From the Research
Pain Management for Cholecystitis
- The optimal pain management for cholecystitis is not explicitly stated in the provided studies, but it can be inferred that analgesics are administered as part of the medical management before an early laparoscopic cholecystectomy (ELC) procedure 2.
- Morphine is traditionally used to treat biliary pain, and its effects on the inflamed gallbladder have been studied. It has been found that morphine reduces the inflammatory fluid secretion by the mucosa in experimental cholecystitis, which may contribute to its pain-relieving effect 3.
- There is no specific mention of the best pain medication for cholecystitis in the other studies, which focus on the diagnosis, treatment, and management of acute cholecystitis 4, 5, 6.
Treatment Approaches for Cholecystitis
- Early laparoscopic cholecystectomy (ELC) is considered the best treatment for acute cholecystitis, with the optimal timeframe for performing ELC being within 72 hours from diagnosis 2, 4.
- For patients who are not eligible for ELC, delaying surgery for at least 6 weeks after clinical presentation is suggested 2.
- Percutaneous or endoscopic gallbladder drainage (GBD) may be considered as a rescue treatment for critically ill patients who are unfit for surgery 2, 6.