Insufflation pressure and its effect on shoulder tip pain after laparoscopic cholecystectomy – A single-blinded, randomised study on 200 patients

Pulle, Mohan Venkatesh; Dey, Ashish; Mittal, Tarun; Mustafa, Taha; Malik, Vinod

doi:10.1016/j.cmrp.2019.05.008

Cited by 5 publications

(2 citation statements)

References 18 publications

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“…Although we observed higher surgeon's satisfaction score in LPCP group in terms of exposure and working space, it was insignificant and except one in LPCP group there was no conversion to high pressure and no intraoperative complications were seen in any group. 16,17 In…”

Section: Discussionmentioning

confidence: 99%

Comparative Study of Low Pressure versus Standard Pressure Carbon Dioxide Pneumoperitoneum in Reducing Shoulder Tip Pain Post Laparoscopic Cholecystectomy

Thapa¹,

Thapa²,

Sharma³

2022

J. Nepalgunj Med. College

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Introduction: Laparoscopic cholecystectomy is the gold standard treatment for cholelithiasis. Postoperative shoulder tip pain is common complaint. Evidences suggest that using low pressure pneumoperitoneum (8-10 mmHg) during the procedure rather than standard pressure (12-14 mmHg) decreases the incidence and severity of shoulder tip pain without compromising working space. Aims: The aim of this study was to evaluate the impact of low pressure and standard pressure pneumoperitoneum on shoulder tip pain post laparoscopic cholecystectomy. Methods: A prospective hospital based study conducted at Nepalgunj Medical College, Kohalpur from January 2019 to December 2020. Hundred patients were enrolled, fifty each in “low pressure carbondioxide pneumoperitoneum” and “standard pressure carbondioxide pneumoperitoneum” groups, who underwent laparoscopic cholecystectomy. The two groups were compared in terms of incidence and severity of shoulder tip pain, surgeon’s satisfaction score, top-up analgesia requirement, procedural time, conversion to standard pressure, intraoperative complications and length of hospital stay. Results: There were 45 (90%) females and five (10%) males in low pressure group and 44 (88%) females and six (12%) males in standard pressure group. Fourteen (28%) patients in low pressure and 32 (64%) patients in standard pressure group had shoulder tip pain (p=0.001). The severity of shoulder tip pain was less in low pressure group and was significant at eight hours (p=0.006) and 12 hours (p=0.008). Top-up analgesia was required more in standard pressure group. There were no intraoperative complications but only one conversion to standard pressure. Surgeon’s satisfaction score, conversion to open cholecystectomy and procedural time were comparable in both groups with shorter hospital stay in low pressure group. Conclusion: Low pressure carbondioxide pneumoperitoneum is safe and effective strategy in reducing incidence and severity of shoulder tip pain after laparoscopic cholecystectomy.

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Section: Discussionmentioning

confidence: 99%

Comparative Study of Low Pressure versus Standard Pressure Carbon Dioxide Pneumoperitoneum in Reducing Shoulder Tip Pain Post Laparoscopic Cholecystectomy

Thapa¹,

Thapa²,

Sharma³

2022

J. Nepalgunj Med. College

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“…Complications from pneumoperitoneum include acid-base imbalances, reduced lung compliance, nausea, and shoulder pain after surgery. [ 3] Numerous researches has demonstrated the advantages of LC over traditional methods. Instantaneous and effective pain control to reduce the pain (VAS) scores (ranges from zero to ten cm) and no additional treatment required after discharge are also acceptable outcomes.…”

Section: Introductionmentioning

confidence: 99%

Low-Pressure Laparoscopic Surgery is a Viable and Risk-Free Alternative to Standard Pressure for the Treatment of Benign Gall Stone

Ali¹,

Naz²,

Sayyed³

et al. 2023

PJMHS

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When compared to the open cholecystectomy, laparoscopic cholecystectomy (LC) has the benefits of less post-operative pain and quicker return to work. However, up to 80% of individuals after laparoscopic surgery still experience significant pain and needing pain relief. Methodology: The reason for this research was to compare the results of LC performed with and without LPP. LC requires the surgeon to choose a pneumoperitoneum pressure that maximizes working space while avoiding unintended side effects. This study used a Randomized Controlled Trial (RCT) design, and it was done at the West Surgical Ward at Mayo Hospital in Lahore. The study enrolled 60 participants who met the inclusion criteria. The patients were split in two groups: Low-pressure pneumoperitoneum-LPP (Group A) (06-10 mm of Hg) and pneumoperitoneum at standard pressure (SPP) is part of Group B. (12-16 mm of Hg). All had opted for a LC to treat their symptomatic gallstone disease. At 4, 8, and 24 hours following surgery, the severity of postoperative shoulder pain (if present) was evaluated using a visual analogue pain scale (VAS). The frequency of postoperative nausea and vomiting was assessed at 4, 8, 12, and 24 hours. Results: The patients were 35.63 years old on average. Majority of these two groups has no complications. Based on the data, we discovered that the frequency of episodes of nausea/vomiting in both groups was very low and that only a few patients had bouts of nausea/vomiting in the 4 hours and 24 hour time intervals. Conclusion: We have come to the conclusion that LP laparoscopic surgery is a viable and risk-free alternative to SP laparoscopic operation for the treatment of benign gall stone disorders. Our findings lead us to the conclusion that LPP is a superior option for the LC since it reduces the post-operative pain in the shoulder and the risk of PONV while not significantly increasing the risk of intraoperative complications. Keywords: Benign Gall Stone, Treatment, Low-Pressure Laparoscopic Surgery,

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Effects of extremely low-pressure pneumoperitoneum on postoperative recovery after single site robot-assisted cholecystectomy: a randomized controlled trial

Park

Hong

2023

Langenbecks Arch Surg

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Purpose A robotic platform has enabled extremely low-pressure pneumoperitoneum (ELPP, 4 mmHg) to reduce surgical insults to human physiology during a minimally invasive surgery. The objective of this study was to investigate effect of ELPP in single-site robotic cholecystectomy (SSRC) on postoperative pain, shoulder pain, and physiological changes during surgery compared to a standard pressure pneumoperitoneum (SPP, 12-14 mmHg).Methods A total of 192 patients who underwent an elective cholecystectomy were randomized into an ELPP SSRC group (n = 91) and an SPP SSRC group (n = 91). Postoperative pain was assessed at 6, 12, 24, and 48 hours after surgery. The number of patients complaining of shoulder pain was observed.Intraoperative changes of ventilatory parameters were also measured.Results Postoperative pain scores (p = 0.038, p < 0.001, p < 0.001, and p = 0.015 at 6, 12, 24, and 48 hours after surgery, respectively) and the number of patients with shoulder pain (p <0.001) were signi cantly lower in the ELPP SSRC group than in the SPP SSRC group. Intraoperative changes in peak inspiratory pressure (p < 0.001), plateau pressure (p < 0.001), EtCO 2 (p < 0.001), and lung compliance (p < 0.001) were also less in the ELPP SSRC group. ConclusionThe ELPP during robotic cholecystectomy could signi cantly relieve postoperative pain and shoulder pain. In addition, the ELPP can reduce changes in lung compliance during surgery and the demand for postoperative analgesics, thereby improving the quality of life of patients during early stages of postoperative rehabilitation.

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Insufflation pressure and its effect on shoulder tip pain after laparoscopic cholecystectomy – A single-blinded, randomised study on 200 patients

Cited by 5 publications

References 18 publications

Comparative Study of Low Pressure versus Standard Pressure Carbon Dioxide Pneumoperitoneum in Reducing Shoulder Tip Pain Post Laparoscopic Cholecystectomy

Comparative Study of Low Pressure versus Standard Pressure Carbon Dioxide Pneumoperitoneum in Reducing Shoulder Tip Pain Post Laparoscopic Cholecystectomy

Low-Pressure Laparoscopic Surgery is a Viable and Risk-Free Alternative to Standard Pressure for the Treatment of Benign Gall Stone

Effects of extremely low-pressure pneumoperitoneum on postoperative recovery after single site robot-assisted cholecystectomy: a randomized controlled trial

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