Residual Pneumoperitoneum Volume and Postlaparoscopic Cholecystectomy Pain

Abstract

Background:Gasretention in the peritoneal cavity plays an important role in inducing postoperative pain after laparoscopy, which is inevitably retained in the peritoneal cavity.Objectives:The aim of this study was to detect the relation between the volume of residual gas and severity of shoulder and abdominal pain.Patients and Methods:In this Prospective study 55 women who were referred for laparoscopic cholecystectomy, were evaluated for the effect of residual pneumoperitoneum on postlaparoscopic cholecystectomy pain intensity. The pneumoperitoneum was graded as absent, mild (1-5 mm), moderate (6-10 mm) and severe (> 11 mm). Patients were followed for postoperative abdominal and shoulder pain using visual analogue scale (VAS), postoperative analgesic requirements, presence of nausea and vomiting, time of unassisted ambulation, time of oral intake and time of return of bowel function in the recovery room and at 6, 12 and 24 hours after operation.Results:At the end of the study, 17 patients (30.9%) had no residual pneumoperitoneum after 24 hours; which 23 (41.81%) had mild residual pneumoperitoneum, eight (14.54%) had moderate pneumoperitoneum and seven (12.72%) had severe pneumoperitoneum. Patients with no or mild residual pneumoperitoneum had significantly lower abdominal and shoulder pain scores than whom with moderate to severe pneumoperitoneum (P = 0.00) and need less meperidine requirements (P = 0.00). Patients did not have any significant difference in time of oral intake, return of bowel function, nausea and vomiting percentages.Conclusions:We conclude that volume of residual pneumoperitoneum is a contributing factor in the etiology of postoperative pain after laparoscopic cholecystectomy.

Laparoscopic Abdominal Surgery Under Regional Anesthesia: A Retrospective Evaluation

“…Postoperatif omuz ağrısı insidansı rejyonal anestezi için %5,3-16 olarak bildirilmektedir ve bizim sonuçlarımıza benzerlik göstermektedir (8,19,20,22,31). Omuz ağrısı residüel karbondioksitin neden olduğu diafragma irritasyonunun bir sonucudur (32). Batın içinde kalan karbondioksit kana difüze olarak ventilasyonla atılır (6).…”

Low-pressure pulmonary recruitment maneuver: equal to or worse than moderate-pressure pulmonary recruitment maneuver in preventing postlaparoscopic shoulder pain? A randomized controlled trial of 72 patients

“…The authors revealed that both length and the height of the subdiaphragmatic gas measured on chest X-rays taken before discharge were significantly correlated with the PLSP score. Supporting the role of residual pneumoperitoneum, the study conducted by Sabzi Sarvestani et al showed that the amount of the residual pneumoperitoneum was directly associated with the intensity of PLSP in subjects scheduled for laparoscopic cholecystectomy [12].…”

Is standardized care feasible in the emergency setting? A case matched analysis of patients undergoing laparoscopic cholecystectomy

“…Several manifestations of laparoscopic cholecystectomy related postoperative pain were described: Visceral pain related to tissue injury and stretching of nerve endings, parietal pain related to port sites and referral shoulder pain related to stretching and irritation of the diaphragm by carbon dioxide gas [8, 9]. Ways to minimize postoperative pain might thus be a restricted number and size of ports [10] or the avoidance of residual pneumoperitoneum at the end of the procedure [9]. …”