The influence of carbon dioxide and nitrous oxide on pain during laparoscopy: a double-blind, controlled trial

Minoli, G; Terruzzi, Vittorio; Spinzi, Giancarlo; Benvenuti, Claudio; Rossini, Aldo A.

doi:10.1016/s0016-5107(82)73045-7

Cited by 47 publications

(19 citation statements)

References 8 publications

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“…As mentioned earlier, nitrous oxide (N20) is better tolerated as an insuffiation gas, based on the senior author's (Dr. Kellum) earlier experience with the gas during diagnostic laparoscopies in awake patients, as well as several reports from the early laparoscopic era. Two separate randomized, prospective, double-blind controlled clinical studies of pelvic laparoscopy under local anesthesia reported that patients experienced statistically less pain with N20 than with CO2 gas insufflation [11,12].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic bilateral inguinal hernia repair under local anesthesia

Pendurthi

DeMaria

1995

Surg Endosc

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A case report of the laparoscopic repair of bilateral inguinal hernias performed under local anesthesia with intravenous sedation is presented. The combination of nitrous oxide for peritoneal insufflation and an ultrasonically activated scalpel for dissection made the procedure feasible. It is hoped that this technique can extend laparoscopic surgery to patients who are poor candidates for general anesthesia.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic bilateral inguinal hernia repair under local anesthesia

Pendurthi

DeMaria

1995

Surg Endosc

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“…Various laparoscopic procedures have been shown to result in better postoperative pulmonary function when compared to their open-surgery counterparts (1b [38,42,48,51,74,112,149,167,197,206,275,307]), but clinically more relevant end points such as postoperative pulmonary complications were rarely evaluated or found unchanged in ASA I and II patients (1b [205,206]). These data generally prove that laparoscopy rather than conventional surgery should be advised for compromised patients, particularly those with obstructive lung disease.…”

Section: Lung Physiology and Gas Exchangementioning

confidence: 99%

“…The following interventions were all shown in RCTs to eectively reduce pain after laparoscopy: · Reducing IAP (1b [178,236,299,308]) · Using other insuation gases, such as N 2 O, helium, or argon (1b [2, 180,206,236,280]), · Lowering the insuation rate (1b [16]) · Warming and humidifying the insuation gas (1b [162,209,210,226,254]) · Removal of residual intraabdominal gas at the end of operation (1b [86,137,298] 87,140,244,264,270]). Since there is also evidence that postlaparoscopic instillation of normal saline or Ringers lactate reduces pain (1b [233]), it is important to distinguish between trials that used placebo controls from those that did not.…”

Section: Pain Nausea and Vomitingmentioning

confidence: 99%

The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery

et al. 2002

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Preoperatively, all patients should be assessed for the presence of cardiac, pulmonary, hepatic, renal, or vascular comorbidity. Presupposing appropriate perioperative measures and surgical technique, there is no reason to contraindicate pneumoperitoneum in patients with peritonitis or intraabdominal malignancy. During laparoscopy, monitoring of end tidal CO2 concentration is mandatory. The available data on closed- (Veress needle) and open-access techniques do not allow us to principally favor the use of either technique. Using 2 to 5-mm instead of 5 to 10-mm trocars improves cosmetic result and postoperative pain marginally. It is recommended to use the lowest intraabdominal pressure allowing adequate exposure of the operative field, rather than using a routine pressure. In patients with limited cardiac, pulmonary, or renal function, abdominal wall lifting combined with low-pressure pneumoperitoneum might be an alternative. Abdominal wall lifting devices have no clinically relevant advantages compared to low-pressure (5-7 mmHg) pneumoperitoneum. In patients with cardiopulmonary diseases, intra- and postoperative arterial blood gas monitoring is recommended. The clinical benefits of warmed, humidified insufflation gas are minor and contradictory. Intraoperative sequential intermittent pneumatic compression of the lower extremities is recommended for all prolonged laparoscopic procedures. For the prevention of postoperative pain a wide range of treatment options exists. Although all these options seem to reduce pain, the data currently do not justify a general recommendation.

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“…Recent studies have suggested the occurrence of peritoneal alterations following PN with carbon dioxide (CO 2 ) [2], such as non-specific clinical reactions, pain (especially in the subscapular region), and tachipnea following laparoscopic surgery.…”

Section: Introductionmentioning

confidence: 99%

Local and systemic impact of pnemoperitoneum on prepuberal rats

et al. 2007

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Pneumoperitoneum (PN) and the gas used to insufflate the abdominal cavity during laparoscopy seem to be responsible for local and systemic modifications. The aim of this study was to verify the effects of intra-abdominal carbon dioxide (CO(2)) and air insufflation on the peritoneum, as well as the cortico-surrenal response in prepuberal rats. Sixty prepuberal rats were divided into three groups: in the first (S, n = 36), PN was induced with CO(2), whereas in the second (A, n = 14), it was induced with filtered room air; in both conditions, insufflation lasted 30 min at a pressure of 10-12 mmHg. The third group (C, n = 10), underwent general anesthesia only. Two hours after inducing anaesthesia, 12 rats in group S, 6 in group A and 6 in group C were killed and the remaining, after 24 h; specimens of the visceral and the parietal peritoneum were obtained for histological examination, blood sample was taken for cortisol and DHEA-S assays at the different study periods. At the histological examination performed 2 h later, the groups S and A presented inflammatory cell infiltrate in the parietal and visceral peritoneum; this finding was even more marked in group A, which presented also congestion, hemorrhage and disruption of the cell line. Twenty-four hours after the experiment, the peritoneum of the two insufflated groups presented chronic infiltrate and reactive mesothelial cells with congestion, which was more evident in group A, but totally absent in group C. Cortisol levels were significantly higher in groups S and A (2.15:1 ratio) killed 2 h later compared to those killed 24 h later and to the control group. DHEA-S levels were not significantly different between the groups. Our results demonstrate that the chemical, physical and molecular impact of CO(2) on the peritoneum causes inflammation and tissue damage, this was even more evident 24 h after our experiment and in the air insufflated group. PN induced a significant variation in blood cortisol levels at 2 h. The CO(2) insufflation should be limited in patients with pre-existing peritoneal damage.

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The influence of carbon dioxide and nitrous oxide on pain during laparoscopy: a double-blind, controlled trial

Cited by 47 publications

References 8 publications

Laparoscopic bilateral inguinal hernia repair under local anesthesia

Laparoscopic bilateral inguinal hernia repair under local anesthesia

The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery

Local and systemic impact of pnemoperitoneum on prepuberal rats

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