Low pressure pneumoperitoneum and intraperitoneal infusion of normal saline for reducing shoulder tip pain after gynecologic laparoscopy: randomized controlled trial

Abstract

Background: To estimate the effectiveness of combined low-pressure pneumoperitoneum (8mmHg) and intraperitoneal normal saline infusion on reducing the incidence and severity of postoperative shoulder tip and upper abdominal pain.Methods: A prospective randomized controlled study was carried out in Aswan University Hospital, Aswan, Egypt. Author included patients undergoing laparoscopic surgery in the laparoscopy unit either diagnostic or operative. They were randomized into two groups: (intervention group) which compromised of 47 patients who underwent low pressure pneumoperitoneum plus intraperitoneal saline infusion and (control group) which included 47 patients underwent standard pressure pneumoperitoneum. The primary outcome of the study is the difference in the mean shoulder tip and upper abdominal pain score postoperatively between the two groups.Results: There was significant reduction in the shoulder tip pain and upper abdominal pain 1, 4, 8, 12 and 24 hours post-operatively shown by visual analogue scale pain scores in the intervention group compared to control (p=0.000). Additionally, there was a significant reduction in the incidence of nausea and vomiting in the intervention group than control group (p=0.000 and p=0.007 respectively). There was no significant difference regards abdominal distention, time of resumption of intestinal peristalsis, operation duration and post-operative hospital stay between the two groups.Conclusions: This study clearly depicts that combined low pressure pneumoperitoneum and intraperitoneal saline infusion is an easy, safe and inexpensive method that significantly reduces the post laparoscopic shoulder tip pain and upper abdominal pain.