Warm and humidified insufflation gas during gynecologic laparoscopic surgery reduces postoperative pain in predisposed patients—a randomized, controlled multi-arm trial

Abstract

Background Postoperative pain remains a common problem in gynecologic laparoscopy, especially in head zone-related regions, triggered by intra-abdominal pressure during capnoperitoneum. Humidified and prewarmed insufflation gas may ameliorate pain and be beneficial. Methods This prospective randomized controlled parallel group multi-arm single-center study investigated the effects of temperature and humidity of insufflation gas on postoperative pain during gynecologic laparoscopy with a duration ≥ 60 min. Female participants (18—70 years) were blinded and randomly assigned—computer generated—to either insufflation with dry cold CO2 with forced air warming blanket (“AIR”), humidified warm gas without forced air warming blanket (“HUMI”), or humidified warm gas with forced air warming blanket (“HUMI +”). We hypothesized that using humidified warm gas resulted in lower pain scores and less analgesic consumption. The primary endpoint postoperative pain was assessed for different pain localizations every 12 h during 7 days after surgery. Secondary endpoints were demand for painkillers and epidural anesthetics, length of stay in recovery room, and hospital stay. (Registration: ClinicalTrials.gov NCT02781194—completed). Results 150 participants were randomized. Compared to group “AIR” (n = 48), there was significantly less pain in group “HUMI +” (n = 48) in the recovery room (− 1.068; 95% CI − 2.08 to − 0.061), as well as significantly less ibuprofen use at day two (− 0.5871 g ± 0.258; p-value = 0.0471). Other variables did not change significantly. Stratification for presence of endometriosis or non-previous abdominal surgery in patient history revealed significantly less pain in both groups “HUMI” (n = 50) and “HUMI +” versus group “AIR.” Related side effects were not noted. Conclusion In the overall population, the use of warm, humidified insufflation gas did not yield clinically relevant effects; however, in predisposed patients with endometriosis and who could otherwise expect high pain levels, warm and humidified gas may be beneficial.

Effect of intraoperative mild hyperventilation on the incidence of shoulder pain after laparoscopic sleeve gastrectomy: A randomized, controlled trial

“…[18] Therefore, most of the techniques used to prevent PLSP or to reduce the incidence were based on reducing physical or chemical stimulation on the surface of the diaphragm. Studies have shown that discharging the remaining intraperitoneal gas by using passive drainage or active aspiration at the end of the procedure can reduce the CO 2 in the peritoneal cavity, [9] applying lung compmanipulation can squeeze out the gas, [23] using gas heating, lowing pneumoperitoneum pressure, [10] low inflation rate and even using gas-free laparoscopy can reduce body irritation, all of which can reduce the incidence of PLSP. Furthermore, PLSP was reduced by inhibition of pain signals itself with anti-inflammatory agents, such as local anesthetic for surface of diaphragm at the beginning or the end of surgery, [24] intraperitoneal infusion of dexmedetomidine, bupivacaine or hydrocortisone, [25] and intraperitoneal or intrathecal injection of clonidine.…”

“…[8] Studies have shown that the incidence of PLSP can be decreased by reducing the pneumoperitoneum pressure, slowing down the speed of the injected gas, and using the heating gas which can reduce the stimulating effect of intraabdominal gas on the diaphragm. [9,10] We speculated that it was not only related to the reduction of intra-abdominal pressure, but probably also to the reduction of CO 2 concentration in blood. Therefore, this study was designded to obeserve the effect of intraoperative mild hyperventilation on the incidence of PLSP after LSG, to verify the above conjecture and provide a reference for reducing the occurrence of PLSP after such surgery.…”

The effect of warm and humidified gas insufflation in gynecological laparoscopy on maintenance of body temperature: a prospective randomized controlled multi-arm trial

“…The trial design was tailored to evaluate the effect on body temperature and therefore did not include second-look laparoscopies which would have been necessary to answer the question of adhesion formation. The effect on postoperative pain was also investigated in this study and published before [15].…”

“…Here, we present the results of our prospective, randomized, controlled monocentric trial [A prospective, randomized, controlled, double-blinded study investigating intraoperative temperature and postoperative pain course following gynecological laparoscopy-TePaLa (Temperature and Pain in Laparoscopy)].The part concerning postoperative pain has been published before [15]. This article describes the parts of the TePaLa trial concerning the patient's temperature during laparoscopy.…”