Prospective Randomized Trial of Low Pressure Pneumoperitoneum for Reduction of Shoulder Tip Pain following Laparoscopic Cholecystectomy: A Comparative Study

Zaman, Muzzafar; Chowdhary, Kunal; Goyal, Pradeep

doi:10.5005/jp-journals-10033-1238

Cited by 3 publications

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“…In another prospective randomized double blind study carried out at MMU, Department of Surgery, Solan among 50 patients also observed only 8% incidence of pain in shoulder tip in LPLC group when compared to SPLC which was 32% and was statistically significant (p=0.012). 12 The observation from the above studies conforms to our observations. In another randomized prospective study conducted in Rajkot India, from July 2014 to October 2016, with a sample size of 50 patients also observed lower postoperative pain referred to the tip of the right shoulder in LPLC group when compared to SPLC group though the difference was not statistically significant 3 which is not similar to the findings of the current study.…”

supporting

confidence: 91%

“…Similar findings were observed by the studies conducted by Zaman et al, 10 Sarli et al 11 and Barczynski et al 12 where they reported no difference in intra-operative complications among both groups. However one of the study observed 43 patients (72.9%) showed no intra-operative complications in the LPLC group but 11 patients (18.6%) had bile spillage and 5 patients (8.5%) had bleeding.…”

supporting

confidence: 89%

“…But again at 24 hours the average pain score between two groups was not significant as observed in our study. In a prospective study conducted by Zaman et al 12 the average pain score in SPLC group was 5.72 and 0.92 in LPLC group and the differences was statistically significant (p0.012). Yet another study by Barczynski et al 10 the mean post operative pain score was 6.18 lower after LPLCprocedure than SPLCand the difference amounted to 22.2% (p < 0.005).…”

mentioning

confidence: 86%

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Prospective randomised trial of standard pressure versus low pressure laparoscopic cholecystectomy in a tertiary care hospital from Kolkata: Our experience

Ghosh

Gangopadhyay

2018

Asian J Med Sci

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Background: Laparoscopic cholecystectomy (LC), the procedure of choice for symptomatic gall stone disease. An emerging trend is to perform Low pressure pnuemoperitonium laparoscopic surgery as it has additive advantages over standard pressure to avoid complications while providing adequate working space.Aims and Objectives: The current study was designed with an aim to compare the advantage of low pressure pneumoperitoneum vs standard pressure pneumoperitoneum in laparoscopic cholecystectomy.Materials and Methods: The study was conducted in the department of General Surgery in R.G.Kar Medical College from January 2014 to June 2015. A total of 52 patients with symptomatic gall stone disease were recruited, 26 patients in each group randomly. Some intraoperative and post-operative parameters were studied.Results: All the intra-operative (IO) cardio-respiratory parameters (Pulse, Mean Arterial Pressure (MAP), End tidal CO2, spO2) were recorded just before incision, 20 minutes intra-operatively and before reversal of general anesthesia (GA). The IO parameters in our study, were found to be significant only at 20 minutes IO and before reversal of GA. The post-operative (PO) parameters (Pulse, MAP, Respiratory rate, spO2) and pain by VAS score at 6 hours, 12 hours and 24 hours post-operatively were studied. In PO period, we observed significant differences at 2 hours post-operatively in all parameters except MAP. There was significant difference in pain at 6, 12 and 24 hours when compared in both groups. The shoulder tip pain (STP) and 2 hours PO nausea and vomiting were found to be significantly higher in Standard pressure Laparoscopic cholecystectomy (SPLC) compared to Low pressure Laparoscopic cholecystectomy (LPLC). The operative time, duration of hospital stay and return to normal life after surgery though had differences but it was statisticallyinsignificant.Conclusion: Low pressure laparoscopic surgery is safe with least post operative complications when performed by experienced surgeons even in patients of ASA III.Asian Journal of Medical Sciences Vol.9(4) 2018 17-22

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confidence: 91%

supporting

confidence: 89%

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confidence: 86%

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Prospective randomised trial of standard pressure versus low pressure laparoscopic cholecystectomy in a tertiary care hospital from Kolkata: Our experience

Ghosh

Gangopadhyay

2018

Asian J Med Sci

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“…Finally, 85 studies were included in the analysis. Study characteristics of the included studies 24 – 108 are presented in Table 1 . There are thirty poor quality studies according to the risk of bias assessment 25 – 28 , 32 , 35 , 41 , 42 , 48 , 50 , 53 , 55 – 58 , 65 , 70 , 72 , 74 , 76 , 78 , 79 , 84 , 87 , 90 , 91 , 97 , 102 , 106 – 108 .…”

Section: Resultsmentioning

confidence: 99%

Low intra-abdominal pressure in laparoscopic surgery: a systematic review and meta-analysis

Reijnders-Boerboom

Albers

Jacobs

et al. 2023

International Journal of Surgery

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Background: Guidelines do not provide clear recommendations with regard to the use of low intra-abdominal pressure (IAP) during laparoscopic surgery. The aim of this meta-analysis is to assess the influence of low versus standard IAP during laparoscopic surgery on the key-outcomes in perioperative medicine as defined by the StEP-COMPAC consensus group. Materials and methods: We searched the Cochrane Library, PubMed, and EMBASE for randomized controlled trials comparing low IAP (<10 mmHg) with standard IAP (10 mmHg or higher) during laparoscopic surgery without time, language, or blinding restrictions. According to the PRISMA guidelines, two review authors independently identified trials and extracted data. Risk ratio (RR), and mean difference (MD), with 95% CIs were calculated using random-effects models with RevMan5. Main outcomes were based on StEP-COMPAC recommendations, and included postoperative complications, postoperative pain, postoperative nausea and vomiting (PONV) scores, and length of hospital stay. Results: Eighty-five studies in a wide range of laparoscopic procedures (7349 patients) were included in this meta-analysis. The available evidence indicates that the use of low IAP (<10 mmHg) leads to a lower incidence of mild (Clavien–Dindo grade 1–2) postoperative complications (RR=0.68, 95% CI: 0.53–0.86), lower pain scores (MD=−0.68, 95% CI: −0.82 to 0.54) and PONV incidence (RR=0.67, 95% CI: 0.51–0.88), and a reduced length of hospital stay (MD=−0.29, 95% CI: −0.46 to 0.11). Low IAP did not increase the risk of intraoperative complications (RR=1.15, 95% CI: 0.77–1.73). Conclusions: Given the established safety and the reduced incidence of mild postoperative complications, lower pain scores, reduced incidence of PONV, and shorter length of stay, the available evidence supports a moderate to strong recommendation (1a level of evidence) in favor of low IAP during laparoscopic surgery.

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“…The advent of laparoscopic cholecystectomy was a milestone achievement in the treatment of gallstones. 5 Laparoscopic cholecystectomy is the gold standard treatment for the management of symptomatic gallbladder. 6 Postoperative pain management is an essential component in surgical patients; if pain management is not done effectively, it may lead to increase in morbidity 7,8 Good analgesia can decrease morbidity and decrease hospital stay postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Injectable Tramadol vs Diclofenac for Postoperative Pain Management in Laparoscopic Cholecystectomy Surgery: A Comparative Prospective Study

Zaman¹,

Chowdhary²,

Shah³

et al. 2018

World Journal of Laparoscopic Surgery With DVD

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Introduction: Laparoscopic management of gallstones is considered as the gold standard treatment nowadays and is the most common surgery done in the present scenario. Postoperative pain remains one of the most common complaints after laparoscopic cholecystectomy and should be managed with proper analgesia with minimal side effects.Aim: To compare the efficacy of injectable tramadol and diclofenac in the pain management after laparoscopic cholecystectomy surgery. Materials and methods: A randomized prospective study was done at Maharishi Markandeshwar College of Medical Science & Research in the Department of General Surgery on 50 patients undergoing laparoscopic surgery between December 2016 and December 2017. Postoperative analgesic is decided randomly with the help of dice. Pain is measured on visual analog scale (VAS) on 6, 12, 18, and 24 hours.Results: A total of 50 patients, divided in two groups I and II, were taken in this study from December 2016 to December 2017 who underwent laparoscopic cholecystectomy. Group I was given injection diclofenac and group II was given injection tramadol postoperatively for pain management 8 hourly. Both I and II groups were matched in all respect with age, weight, and operative time. Pain relief after diclofenac first dose postoperatively in 8 hours was seen in 7 patients, in 9 to 16 hours in 12 patients, and 17 to 24 hours in 18 patients. Pain relief after tramadol first dose postoperatively in 8 hours was seen in 16 patients, in 9 to 16 hours in 21 patients, and 17 to 24 hours in 25 patients. Postoperatively, patients complained of nausea and vomiting. Group II having tramadol infusion complained of higher incidence of nausea and vomiting as compared with group I having diclofenac for pain management. Conclusion:Pain after laparoscopic cholecystectomy is a common complaint encountered. Good analgesia should be given to patients but should have minimal side effects. It was concluded from our study that tramadol in injectable form is WJOLS

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Prospective Randomized Trial of Low Pressure Pneumoperitoneum for Reduction of Shoulder Tip Pain following Laparoscopic Cholecystectomy: A Comparative Study

Cited by 3 publications

References 0 publications

Prospective randomised trial of standard pressure versus low pressure laparoscopic cholecystectomy in a tertiary care hospital from Kolkata: Our experience

Prospective randomised trial of standard pressure versus low pressure laparoscopic cholecystectomy in a tertiary care hospital from Kolkata: Our experience

Low intra-abdominal pressure in laparoscopic surgery: a systematic review and meta-analysis

Injectable Tramadol vs Diclofenac for Postoperative Pain Management in Laparoscopic Cholecystectomy Surgery: A Comparative Prospective Study

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