OpenLB
Open Library of Bioscience
Advanced Search
Surgical endoscopy
03, 2017;31 (3): 1287-1295.

Impact of standard-pressure and low-pressure pneumoperitoneum on shoulder pain following laparoscopic cholecystectomy: a randomised controlled trial.

Hemanga K Bhattacharjee, Azarudeen Jalaludeen, Virinder Bansal, Asuri Krishna, Subodh Kumar, Rajeshwari Subramanium, Rashmi Ramachandran, Mahesh Misra
Author Information
  1. Hemanga K Bhattacharjee: Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
  2. Azarudeen Jalaludeen: Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
  3. Virinder Bansal: Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India. drvkbansal@gmail.com.
  4. Asuri Krishna: Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
  5. Subodh Kumar: Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
  6. Rajeshwari Subramanium: Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India.
  7. Rashmi Ramachandran: Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India.
  8. Mahesh Misra: Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
PMID: 27444831 DOI: 10.1007/s00464-016-5108-2

Abstract

BACKGROUND: The incidence of shoulder pain (SP) following laparoscopic cholecystectomy (LC) varies between 21 and 80 %. A few randomised controlled trials and meta-analysis have shown lesser SP in LC performed under low-pressure carbon dioxide pneumoperitoneum (LPCP) than under standard-pressure carbon dioxide pneumoperitoneum (SPCP). However, the possible compromise in adequate exposure and effective working space during LPCP has negatively influenced its uniform adoption for LC.
MATERIALS AND METHODS: All consecutive patients undergoing elective LC for gallstone disease who met the inclusion and exclusion criteria were enroled. Fourty patients were randomised to SPCP group (pressure of 14 mmHg) and 40 to LPCP group (pressure of 9-10 mmHg). Primary outcome measured was incidence of SP and its severity on visual analogue scale (VAS) at 4, 8, 24 h and 7 days after LC. Secondary outcomes measured were procedural time, technical difficulty, surgeons' satisfaction score on exposure and working space, intra-operative changes in heart rate and blood pressure, abdominal pain and analgesic requirement. Analyses were performed using Stata software.
RESULTS: There was no conversion to open surgery, bile duct injury or need to increase intra-abdominal pressure on either group. Twenty-three patients (57.5 %) in SPCP group and nine patients (22.5 %) in LPCP group had SP (p = 0.001). The severity of SP was significantly more in SPCP group at 8 and 24 h (p = 0.009 and 0.005, respectively). Both the groups had similar procedural time, surgeons' satisfaction score, intra-operative changes in heart rate and blood pressure.
CONCLUSION: The incidence and severity of SP following LC performed at LPCP are significantly less compared to that in SPCP. The safety, efficacy and surgeons' satisfaction appear to be comparable in both the groups. Hence, a routine practice of low-pressure carbon dioxide pneumoperitoneum may be recommended in selected group of patients undergoing laparoscopic cholecystectomy.
CLINICAL TRIAL REGISTRATION NUMBER: CTRI/2016/02/006590.

Keywords

Laparoscopic cholecystectomy Low-pressure pneumoperitoneum Shoulder pain Standard-pressure pneumoperitoneum Surgeons’ satisfaction

References

  1. Surg Laparosc Endosc Percutan Tech. 2006 Dec;16(6):383-6 [PMID: 17277653]
  2. Surg Endosc. 2009 May;23(5):1044-7 [PMID: 18810547]
  3. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD006930 [PMID: 19370662]
  4. Am J Surg. 2014 Jul;208(1):143-50 [PMID: 24503370]
  5. J Laparoendosc Adv Surg Tech A. 2010 Oct;20(8):677-82 [PMID: 20701547]
  6. Surg Endosc. 2013 Jul;27(7):2275-82 [PMID: 23340814]
  7. Surg Laparosc Endosc Percutan Tech. 2014 Apr;24(2):127-33 [PMID: 24686347]
  8. Anesth Analg. 1994 Jul;79(1):152-4 [PMID: 8010427]
  9. Cochrane Database Syst Rev. 2014 Mar 18;(3):CD006930 [PMID: 24639018]
  10. Trop Gastroenterol. 2009 Jul-Sep;30(3):171-4 [PMID: 20306755]
  11. Anesth Pain Med. 2014 Sep 14;4(4):e17366 [PMID: 25599023]
  12. Surg Endosc. 2003 Apr;17(4):533-8 [PMID: 12582754]
  13. Arch Surg. 2011 Dec;146(12):1360-6 [PMID: 22184293]
  14. Br J Surg. 2000 Sep;87(9):1161-5 [PMID: 10971421]
  15. World J Surg. 2006 Nov;30(11):1969-73 [PMID: 17043939]
  16. Surg Laparosc Endosc Percutan Tech. 2003 Aug;13(4):245-9 [PMID: 12960786]
  17. J Minim Invasive Gynecol. 2014 May-Jun;21(3):466-71 [PMID: 24374246]
  18. Surgeon. 2012 Apr;10(2):71-4 [PMID: 22385527]
  19. Middle East J Anaesthesiol. 2006 Feb;18(4):757-68 [PMID: 16749570]
  20. Saudi Med J. 2012 Feb;33(2):134-8 [PMID: 22327752]

MeSH Term

Adult
Cholecystectomy, Laparoscopic
Female
Humans
Male
Pneumoperitoneum, Artificial
Postoperative Complications
Shoulder Pain
Visual Analog Scale
Journal Article Randomized Controlled Trial

Word Cloud

Created with Highcharts 10.0.0groupSPLCpneumoperitoneumLPCPSPCPpatientspressurepainsatisfactionincidencefollowinglaparoscopiccholecystectomyrandomisedperformedlow-pressurecarbondioxideseveritysurgeons'shouldercontrolledstandard-pressureexposureworkingspaceundergoingmeasured824 hproceduraltimescoreintra-operativechangesheartrateblood5 %p = 0significantlygroupsBACKGROUND:varies2180 %trialsmeta-analysisshownlesserHoweverpossiblecompromiseadequateeffectivenegativelyinfluenceduniformadoptionMATERIALSANDMETHODS:consecutiveelectivegallstonediseasemetinclusionexclusioncriteriaenroledFourty14 mmHg409-10 mmHgPrimaryoutcomevisualanaloguescaleVAS47 daysSecondaryoutcomestechnicaldifficultyabdominalanalgesicrequirementAnalysesusingStatasoftwareRESULTS:conversionopensurgerybileductinjuryneedincreaseintra-abdominaleitherTwenty-three57nine220010090005respectivelysimilarCONCLUSION:lesscomparedsafetyefficacyappearcomparableHenceroutinepracticemayrecommendedselectedCLINICALTRIALREGISTRATIONNUMBER:CTRI/2016/02/006590Impactcholecystectomy:trialLaparoscopicLow-pressureShoulderStandard-pressureSurgeons’

Similar Articles

Cited By