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Peritoneal limited conditioning reduces postoperative pain: a randomized controlled trial in robot-assisted laparoscopic myomectomy

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Gynecological Surgery

Abstract

Postoperative pain is related to the gas used for laparoscopy as demonstrated for 100 % nitrous oxide in 2002 by Tsereteli. In a previous trial, we demonstrated that the use of full conditioning adding 10 % nitrous oxide and 4 % oxygen to the CO2 pneumoperitoneum with humidification and altering the temperature of the insufflation gas, the use of Hyalobarrier gel, and the administration of 5 mg dexamethasone significantly reduced postoperative pain and decreased adhesions. As we believed that just altering the insufflation gas by adding 10 % of nitrous oxide and 4 % of oxygen would reduce pain and adhesions by itself, we performed a randomized controlled trial on women undergoing robot-assisted laparoscopic myomectomy. Fourteen women undergoing robot-assisted laparoscopic myomectomy were randomized 1:1 receiving 86 % CO2 + 10 % N2O + 4 % O2 or 100 % CO2. Outcome parameters were postoperative pain (visual analog scale (VAS)) and adhesions observed at second-look laparoscopy after 14 days. Pain and painkiller intake were significantly reduced by using the altered insufflation gas (p < 0.05). Adhesions did not show a significant difference, although the study group tended to have less adhesions (p < 0.21). Addition of 10 % N2O and 4 % O2 to the pneumoperitoneum significantly decreased postoperative pain, even in a low number of participants, which suggests a strong effect.

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Authors’ contribution

N Storme: data management and manuscript writing

S Pacquée: project development and data collection

M Ampe: data analysis

A Creemers: data analysis

J Verguts: protocol/project development, data collection or management, and manuscript editing

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University Hospital KU Leuven Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium

    Nathalie Storme, Stefaan Pacquée & Jasper Verguts

  2. Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BIOSTAT), Center for Statistics (CenStat), Hasselt University, 3500, Hasselt, Belgium

    Michèle Ampe & An Creemers

  3. Department of Obstetrics and Gynecology, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium

    Jasper Verguts

Authors
  1. Nathalie Storme
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  2. Stefaan Pacquée
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Correspondence to Jasper Verguts.

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The authors declare that they have no conflict of interest.

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Informed consent was obtained from all patients for being included in the study.

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Storme, N., Pacquée, S., Ampe, M. et al. Peritoneal limited conditioning reduces postoperative pain: a randomized controlled trial in robot-assisted laparoscopic myomectomy. Gynecol Surg 13, 139–146 (2016). https://doi.org/10.1007/s10397-016-0941-9

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  • DOI: https://doi.org/10.1007/s10397-016-0941-9

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