Randomized, Prospective Comparison of Post-Operative Pain In Low - Versus High -Pressure Pneumoperitoneum in Laparoscopic Cholecystectomy

Ali A. Al-Dabbagh; Nabaz Hassan Ismaeel

doi:10.15218/zjms.2010.020

Authors

Ali A. Al-Dabbagh FICMS, General surgeon, Rizgary Teaching Hospital. College of Medicine/Hawler Medical University .
Nabaz Hassan Ismaeel DGS ,General surgeon, Mergasor Hospital. .

DOI:

https://doi.org/10.15218/zjms.2010.020

Keywords:

Laparoscopic cholecystectomy, pneumoperitoneum, postoperative pain

Abstract

Background and objective: CO2 insuflation constitutes the commonest means of creat-ing the pneumoperitoneum (PP), but it is attributed to many post-laparoscopic cholecyste-comy adverse effects including pain triggering. The aim of this trial was to evaluate the effi-cacy of low-pressure CO2 PP during laparoscopic cholecystectomy (LC) in reducing the incidence of postoperative pain.

Methods: A double-blind, randomized, clinical trial was conducted on 100 patients with symptomatic gall stones. Patients were randomized preoperatively into group A (n=50) who underwent LC with 8 mmHg CO2 PP throughout the procedure and those in group B (n=50) had LC with 12 mmHg CO2 PP. Abdominal and shoulder-tip pain were assessed with verbal rating scale (VRS) scoring at 4, 8, 12 and 24 hours postoperatively.

Results: The low-pressure PP did not increase the duration of surgery. There were neither significant peri-operative complications nor conversion to open procedure in either group. A statistical comparison of mean cumulative VRS scores for abdominal and shoulder-tip pain in both groups shows statistical significance at 4, 8, 12 and 24 hours after operation.

Conclusion: A CO2 PP at 8 mmHg reduces both the frequency and intensity of abdomi-nal and shoulder-tip pain following LC without increasing the rate of intra-operative compli-cations.

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