Patient Selection

• Standard

Anaesthetic Techniques

• Short acting general anaesthetic – TIVA using propofol + remifentanil recommended
• Intubation or laryngeal mask and IPPV ventilation. Air/ O₂ only
• Short duration muscle relaxants
• Routine IV fluids. Minimum 1000mls Plasma-Lyte 148 ®
• Routine anti-emesis (IV ondansetron 4mg AND dexamethasone 6.6mg). High incidence of PONV with Cholecystectomy

Surgical Technique

• Standard positioning of patient, with slight head up, table rotation towards surgeon. Use intermittent pneumatic compression for DVT prophylaxis.
• Local anaesthetic to all port sites before insertion of ports (10mls 0.5% bupivacaine*)
• Use of three 5mm ports and one 10mm port
• Low pressure CO₂ insufflation (10mmHg)
• Meticulous washout at end of procedure
• Instillation of 30mls 0.25% bupivacaine* around liver and gallbladder. No drains

*This total dose is the maximum for a patient of 62kg

Peri-Operative Analgesia

• Pre-operative: oral paracetamol 1g (500mg if weight <50kg) + NSAID✩
• Intraoperative: IV fentanyl 250-400microgram (avoid long-acting opioid). Analgesic requirement varies greatly between patients
• Post-operative: regular paracetamol + NSAID✩
• Rescue: IV fentanyl +/- oral morphine solution

Take Home Medication as per the day case TTO guidelines for adults (weight >50kg)

• Paracetamol 1g oral QDS (32 tablets, 500mg each)
• Ibuprofen 400 oral QDS✩ (24 tablets, 400mg each)
• Codeine 30-60mg QDS (28 tablets, 30mg each)
• Macrogol 1 sachet BD

If patient unable to take NSAIDs

• Paracetamol 1g oral QDS (32 tablets, 500mg each)
• Morphine sulphate oral solution 10-20mg QDS (1 bottle 100ml/200mg)
• Ondansetron 4mg TDS (6 tablets, 4mg each)
• Macrogol 1 sachet BD

✩ unless contraindicated

Organisational Considerations

• Ensure admission to day case ward
• Early introduction of fluids, diet and mobilisation
• Follow bladder management flowchart if not passed urine

Anticipated Day Case Rate

Anticipated Day Case Rate 75%