Impact of standard-pressure and low-pressure pneumoperitoneum on shoulder pain following laparoscopic cholecystectomy: a randomised controlled trial

Bhattacharjee, Hemanga K.; Jalaludeen, Azarudeen; Bansal, Virinder Kumar; Krishna, Asuri; Kumar, Subodh; Subramanium, Rajeshwari; Ramachandran, Rashmi; Misra, Mahesh Chandra

doi:10.1007/s00464-016-5108-2

Cited by 44 publications

(31 citation statements)

References 17 publications

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“…Low-pressure (8-9 mmHg) pneumoperitoneum was established. It is reported that low-pressure pneumoperitoneum is advantageous in reducing the incidence of shoulder and neck pain 13,14 ; the ERAS society points to its potential in mitigating the negative impact of CO 2 15,16 . 2.…”

Section: Surgerymentioning

confidence: 99%

Evaluation of enhanced recovery after surgery program components implemented in laparoscopic appendectomy: prospective randomized clinical study

Nechay

Сажин

Titkova

et al. 2020

Sci Rep

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Background Laparoscopic appendectomy (LA) is a widely used surgical procedure. Patients often suffer from considerable postoperative pain and indigestion, which prolongs their in-hospital stay. Almost 10% of patients develop postoperative complications. The enhanced recovery after surgery (ERAS) program has proven its efficacy in elective surgery and could hypothetically improve LA outcomes. Currently, there is no ERAS program for LA. Methods A modified ERAS (mERAS) protocol was studied in a prospective, randomized nonblinded clinical trial. The mERAS group consisted of 50 patients; the control group, of 54 patients. The mERAS protocol included a patient information brochure; minimizing drain use; local anesthesia; low-pressure pneumoperitoneum; early mobilization and oral diet. The primary outcome was postoperative length of stay (pLOS). Results Modified protocol reduced median pLOS to 1.25 days vs 2 days in the controls (p < 0.0001). Twenty-one (42%) mERAS patients and 4 (7.4%) controls were discharged within 24 h (p < 0.001) after surgery; 0 readmissions were reported. Postoperative pain intensity assessed on the visual analogue scale was significantly lower in the mERAS group [mERAS vs control 0

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Section: Surgerymentioning

confidence: 99%

Evaluation of enhanced recovery after surgery program components implemented in laparoscopic appendectomy: prospective randomized clinical study

Nechay

Сажин

Titkova

et al. 2020

Sci Rep

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“…Various studies on shoulder tip pain post cholecystectomy under low pressure had shown similar results. [7][8][9][10] There were no long term complications.…”

Section: Discussionmentioning

confidence: 87%

Comparative Analysis of Hemodynamic Changes and Shoulder Tip Pain Under Standard Pressure Versus Low-pressure Pneumoperitoneum in Laparoscopic Cholecystectomy

Goel¹,

Gupta²,

Bhagat³

et al. 2019

Euroasian Journal of Hepato-Gastroenterology

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Background: Laparoscopic cholecystectomy is the gold standard procedure for cholelithiasis. Pneumoperitoneum is created using carbon dioxide (CO 2) , which is usually maintained at a range of 12-14 mm Hg. An emerging trend has been the use of low-pressure pneumoperitoneum in the range of 7-10 mm Hg in an attempt to lower the impact of pneumoperitoneum on the human physiology while providing adequate working space. Our study proposes to compare the effects of low-pressure pneumoperitoneum with the use of standard pressure of pneumoperitoneum. Aims and objective: To compare and analyze various factors like blood pressure, heart rate, end-tidal CO 2 and postoperative shoulder tip pain in cases undergoing laparoscopic cholecystectomy using standard pressure versus low pressure. Materials and methods: This is a prospective randomized study carried out at Santosh Medical College and Hospitals, Ghaziabad from September 2017 to December 2018. This study included 60 patients of cholelithiasis which were divided into two groups of 30 patients each. Group I was offered laparoscopic cholecystectomy under standard pressure pneumoperitoneum and group II underwent laparoscopic cholecystectomy using low-pressure pneumoperitoneum. Patients in each group were evaluated for various intraoperative physiological changes and postoperative shoulder tip pain. Observations and results: Cholelithiasis is commonly seen in middle-aged females. There is no significant difference in duration of surgery between the two groups. However, various factors like systolic blood pressure, heart rate, end-tidal CO 2 were significantly better in the lowpressure group. Postoperative shoulder tip pain (measured by VAS scoring system) was significantly less in the low-pressure group during the first 24 hours. Conclusion: Laparoscopic cholecystectomy under low-pressure pneumoperitoneum causes minimal physiological changes and less postoperative shoulder tip pain.

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“…4,5 Their safety, efficacy, near-equal operative time and surgeon's satisfaction appear to be comparable with standard-pressure pneumoperitoneum. [18][19][20] Patients drain group had a statistically significant longer stay as compared to the group without drain due to the fact that none of patients in the drain group could be discharged before removal of the drain. Authors conclude that the routine use of a drain in elective uncomplicated laparoscopic cholecystectomy in patients with liver cirrhosis has nothing to offer; in contrast, it is associated with increased pain.…”

Section: Discussionmentioning

confidence: 97%

Laparoscopic cholecystectomy in hepatitis C liver cirrhosis patients: “to drain or not to drain: impact on postoperative pain”

et al. 2019

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Background: When cirrhotic patients with symptomatic gallstones require laparoscopic cholecystectomy (LC), the drainage tube is supposed to prevent postoperative abdominal radiating to the right shoulder, nausea and vomiting due to pneumoperitoneum using carbon dioxide gas. Aim of this work is to evaluate the effect of placing of drains on the incidence of postoperative pain, nausea and vomiting in those patients.Methods: sixty-four patients with uncomplicated chronic calcular cholecystitis and liver cirrhosis were recruited for the study during the period from February 2017 to February 2019. They electively operated upon at the department of general surgery of Theodor Bilharz Research Institute (TBRI) using laparoscopic technique. Patients were subdivided into two equal groups Group-I (n=32); suction drains were placed in the sub-hepatic region (Morison’s pouch) and Group-II (n=32), no drains were placed. Duration of surgery, postoperative shoulder tip pain and vomiting and analgesics requirement were evaluated and recorded.Results: Operative time's difference was not statistically significant between the two groups. Drain group had a significant lower shoulder tip pain and analgesic requirement at post-operative 6 and 12 hours but that was higher After 12 hours, than group without drain. The overall incidence of nausea/vomiting was significantly higher statistically in group without drain than in drain group. Patients in drain group had a significantly longer hospital stay as compared to group without drain that was statistically significant.Conclusions: Although the incidence of pain and nausea/vomiting are less in early post-operative period after LC with abdominal drain in hepatitis C liver cirrhosis patients; its routine use is not justified because post-operative pain and analgesic requirement after 12 hours is higher and hospital stay is longer.

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Impact of standard-pressure and low-pressure pneumoperitoneum on shoulder pain following laparoscopic cholecystectomy: a randomised controlled trial

Abstract: CTRI/2016/02/006590.

Cited by 44 publications

References 17 publications

Evaluation of enhanced recovery after surgery program components implemented in laparoscopic appendectomy: prospective randomized clinical study

Evaluation of enhanced recovery after surgery program components implemented in laparoscopic appendectomy: prospective randomized clinical study

Comparative Analysis of Hemodynamic Changes and Shoulder Tip Pain Under Standard Pressure Versus Low-pressure Pneumoperitoneum in Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy in hepatitis C liver cirrhosis patients: “to drain or not to drain: impact on postoperative pain”

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