Laparoscopie ou laparotomie pour colectomie : comment la voie d'abord influence la prise en charge de la douleur postopératoire

Colectomy is one of the most common abdominal surgical procedures that is performed either by laparotomy or, more and more frequently, by laparoscopy. Most of postoperative pain control guidelines refer to laparotomy, while pain is supposed to be less important after laparoscopic surgery. Epidural analgesia, considered as the gold standard after laparotomy is not worth performing after laparoscopic surgery. It is nevertheless recommended to reduce opioid demand in order to avoid a prolongation of postoperative ileus leading to prolonged in hospital stay. This approach is supported by a multimodal analgesic strategy resulting from the combined use of non opioid analgesic and antihyperalgesic agents such as intravenous lidocaine and ketamine. A rapid oral feeding and deambulation remain integral parts of postoperative rehabilitation after laparoscopic and open surgery as well.