A randomized controlled trial to determine the effect of humidified carbon dioxide (CO2) insufflation on postoperative pain following thoracoscopic procedures

Mouton, Wolfgang G.; Naef, Markus; Bessell, J. R.; Otten, Kars; Wagner, H.E.; Maddern, Guy J.

doi:10.1007/s004640090055

Cited by 24 publications

(16 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The insuflow has been shown to decrease perioperative pain by heating and humidifying the CO 2 [2,8]. But others [9] challenge these findings by showing no pain reduction when comparing heated and humidified CO2 to cold and dry CO 2 during gynecologic laparoscopy.…”

Section: Discussionmentioning

confidence: 80%

The effect of continuous intraabdominal nebulization of lidocaine during gynecological laparoscopic procedures- a pilot study

et al. 2008

View full text Add to dashboard Cite

Although laparoscopic surgery is known to cause less postoperative pain when compared to laparotomy, some patients still suffer from excessive pain, especially during the first stages of recovery. The purpose of our study was to assess the effect of intraperitoneal nebulization of lidocaine during gynecological laparoscopic procedures on perioperative pain. The study was a prospective, randomized, double-blinded, placebo-controlled trial (Canadian task force classification I) that included 23 patients who underwent outpatient gynecological laparoscopic procedures. Patients were randomly assigned either to a study group that received 5 mg/kg of lidocaine intraperitonealy during surgery (n=15) or to a control group that received sterile water in the same manner (n=8). The fluid was infuslated along with the CO 2 through a Insuflow® device. All patients received the same anesthetic technique. Intraoperative pain as assessed by changes in the vital signs was treated with fentanyl. Postoperative pain was evaluated according to postoperative opioid requirements and by the Visual Analogue Scale (VAS) at 15 min, 1 h and 24 h postoperatively. The VAS score was found to be lower for the study group 1 h after surgery (p=0.023). There was no difference in the VAS scores at 15 min (p=0.9) and 24 h (p=0.11) after surgery. A correlation analysis showed no association between the amount of lidocaine insufflated and the severity of the postoperative pain. There was no difference in terms of fentanyl administration during surgery or opiod consumption following surgery between the groups. We concluded that continuous intraperitoneal insuflation of lidocaine using an Insuflow® device may significantly reduce pain in the initial stage of postoperative recovery.

show abstract

Section: Discussionmentioning

confidence: 80%

The effect of continuous intraabdominal nebulization of lidocaine during gynecological laparoscopic procedures- a pilot study

et al. 2008

View full text Add to dashboard Cite

show abstract

“…Surgeons in various specialities have advocated the use of peritoneal local anesthetics or fluids such as normal saline [1, 3, 8, 17, 20, 24-26, 29-31, 34]. In addition, many published data advocate the use of warmed and humidified insufflating gas as a method of reducing pain [13,16,21,23,27]. None of these measures have been successful in reducing postlaparoscopic pain.…”

Section: Discussionmentioning

confidence: 99%

“…The causes include initiation of pneumoperitoneum, type of insufflated gas and intraabdominal pH, residual intraperitoneal gas, gas temperature, humidity, and the use of certain anesthetic and antiinflammatory drugs. Additional contributing factors include access-related pain, sociocultural status, and individual factors [15,[21][22][23]28].…”

mentioning

confidence: 99%

Intraperitoneal aerosolization of bupivacaine reduces postoperative pain in laparoscopic surgery: a randomized prospective controlled double-blinded clinical trial

et al. 2006

View full text Add to dashboard Cite

show abstract

“…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

View full text Add to dashboard Cite

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.

show abstract

A randomized controlled trial to determine the effect of humidified carbon dioxide (CO2) insufflation on postoperative pain following thoracoscopic procedures

Abstract: The use of humidified gas appears to reduce postoperative pain but not the rate of respiratory complications.

Cited by 24 publications

References 10 publications

The effect of continuous intraabdominal nebulization of lidocaine during gynecological laparoscopic procedures- a pilot study

The effect of continuous intraabdominal nebulization of lidocaine during gynecological laparoscopic procedures- a pilot study

Intraperitoneal aerosolization of bupivacaine reduces postoperative pain in laparoscopic surgery: a randomized prospective controlled double-blinded clinical trial

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

Contact Info

Product

Resources

About