Introduction
This audit evaluates compliance with updated day-case laparoscopic cholecystectomy guidelines, focusing on perioperative analgesia in alignment with the British Association of Day Case Surgery standards. Optimizing analgesic protocols is critical to minimize long-acting opioids, enhance pain control, and improve same-day discharge rates.
Methods
A retrospective analysis was conducted on 90 patients (63 female, 27 male), aged 19–85 years (mean age: 48), ASA classifications I–III and mean BMI of 29.66. Compliance was assessed across premedication, intraoperative management, and postoperative analgesia. Data collected included pain scores, recovery time, rescue analgesia, and day-case discharge rates.
Results
High compliance was noted intraoperatively with routine antiemetics and local anesthetic use. Opioids frequently administered included fentanyl (78.8%) and morphine (41.1%). Only 8.8% received preoperative analgesia, with combined paracetamol and ibuprofen resulting in the lowest postoperative pain scores. 34.4% of patients reported no postoperative pain, correlating with shorter recovery times (47.5 vs 68.5 minutes). Fentanyl use delayed peak pain when combined with other intraoperative agents. Postoperative rescue analgesia was required in 64.4%, most commonly tramadol (36.7%). Same-day discharge was achieved for 76 patients (84.4%).
Conclusions
The audit demonstrates improved discharge outcomes from the revised anaesthetic protocol but identifies preoperative analgesia compliance as an area needing improvement. Findings suggest that preoperative NSAIDs improve pain control and speed recovery.
An action plan involving staff education, updated preoperative checklists, and new directives for routine NSAIDs (paracetamol or long-acting ibuprofen 1600 mg) has been implemented. A re-audit will assess the effectiveness of these interventions for continuous quality improvement.
Authors
Daniela De Avila
University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
Hiteshkumar Patel
University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
Yuvraj Kukreja
University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
Vipul Kaushik
University Hospitals of Leicester NHS Trust, Leicester, United Kingdom