Randomized Comparison Between Different Insufflation Pressures for Laparoscopic Cholecystectomy

Abstract

Laparoscopy using carbon dioxide insufflation induces adverse effects in both the cardiovascular and the respiratory function. The use of low pressure pneumoperitoneum has been shown to reduce adverse hemodynamic effects. However, its effect on tissue trauma and postoperative pain and recovery remains controversial. The aim of this study was to compare tissue trauma, postoperative pain, and recovery in two groups of patients undergoing laparoscopic cholecystectomy, one at insufflation pressure of 8 (LC8) and the other at 15 mm Hg (LC15). Forty patients were randomized, 20 in each group. The characteristics of the patients were similar in the two groups. The procedure was completed in all patients in the LC15 group, but in 2 patients in the LC8 group the pressure was increased to 15 mm Hg to complete the operation. There were no significant differences in postoperative pain scores, analgesic consumption, and the incidence of nausea, vomiting, and shoulder pain between the two groups. C-reactive protein concentrations and white blood cell count rose significantly after surgery, but the increase was similar in the two groups. The median duration of surgery was similar, 23 minutes (range 15-65) in the LC8 group and 25 minutes (range 15-80) in the LC15 group. Using our technique of laparoscopic cholecystectomy, there were no advantages to tissue damage, postoperative pain, and recovery when a low pressure pneumoperitoneum was used.

Shoulder Tip Pain Following Laparoscopic Cholecystectomy—a Randomized Control Study to Determine the Cause

“…Some studies have also shown that the shoulder tip pain is minimal if the initial insufflation rate is kept suboptimal, although this needs to be substantiated. Some studies have shown that the incidence and intensity of postoperative shoulder tip pain was significantly less in the low-pressure pneumoperitoneum group when compared with standard-pressure pneumoperitoneum groups [8,[11][12][13][14][15][16]. Our study, however, shows that the incidence of shoulder pain has no statistical difference between groups undergoing laparoscopic surgery at different pneumoperitoneal pressures.…”

Low-pressure pneumoperitoneum combined with intraperitoneal saline washout for reduction of pain after laparoscopic cholecystectomy: a prospective randomized study

“…The effect is maintained for 3-5 postoperative days, thus contributing to an improved QOL for these patients, chiefly in the physical domain [2,3,14,19,20]. Yet not all investigators are uniformly positive in their assessment of LP [13]. Most likely, the differences become statistically significant only in trials involving larger groups of patients [3,14].…”

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

“…15 However Celik et al and Perrakis et al have shown that the pressure levels did not affect pain scores. 16,17 Wallace et al compared 7.5 and 15mmHg pressure and reported less pain in the LPG. 18 Vilos et al, the intraperitoneal pressure was correlated positively with BMI and weight and negatively with parity.…”