Abstract
Background
The incidence of shoulder pain (SP) following laparoscopic cholecystectomy (LC) varies between 21 and 80 %. A few randomised controlled trials and meta-analysis have shown lesser SP in LC performed under low-pressure carbon dioxide pneumoperitoneum (LPCP) than under standard-pressure carbon dioxide pneumoperitoneum (SPCP). However, the possible compromise in adequate exposure and effective working space during LPCP has negatively influenced its uniform adoption for LC.
Materials and methods
All consecutive patients undergoing elective LC for gallstone disease who met the inclusion and exclusion criteria were enroled. Fourty patients were randomised to SPCP group (pressure of 14 mmHg) and 40 to LPCP group (pressure of 9–10 mmHg). Primary outcome measured was incidence of SP and its severity on visual analogue scale (VAS) at 4, 8, 24 h and 7 days after LC. Secondary outcomes measured were procedural time, technical difficulty, surgeons’ satisfaction score on exposure and working space, intra-operative changes in heart rate and blood pressure, abdominal pain and analgesic requirement. Analyses were performed using Stata software.
Results
There was no conversion to open surgery, bile duct injury or need to increase intra-abdominal pressure on either group. Twenty-three patients (57.5 %) in SPCP group and nine patients (22.5 %) in LPCP group had SP (p = 0.001). The severity of SP was significantly more in SPCP group at 8 and 24 h (p = 0.009 and 0.005, respectively). Both the groups had similar procedural time, surgeons’ satisfaction score, intra-operative changes in heart rate and blood pressure.
Conclusion
The incidence and severity of SP following LC performed at LPCP are significantly less compared to that in SPCP. The safety, efficacy and surgeons’ satisfaction appear to be comparable in both the groups. Hence, a routine practice of low-pressure carbon dioxide pneumoperitoneum may be recommended in selected group of patients undergoing laparoscopic cholecystectomy.
Clinical trial registration number
CTRI/2016/02/006590.
Similar content being viewed by others
References
Sarli L, Costi R, Sansebastiano G, Trivelli M, Roncoroni L (2000) Prospective randomized trial of low-pressure pneumoperitoneum for reduction of shoulder-tip pain following laparoscopy. Br J Surg 87:1161–1165
Kandil TS, El Hefnawy E (2010) Shoulder pain following laparoscopic cholecystectomy: factors affecting the incidence and severity. J Laparoendosc Adv Surg Tech A 20:677–682
Tsai HW, Chen YJ, Ho CM, Hseu SS, Chao KC, Tsai SK, Wang PH (2011) Maneuvers to decrease laparoscopy-induced shoulder and upper abdominal pain: a randomized controlled study. Arch Surg 146:1360–1366
Donatsky AM, Bjerrum F, Gögenur I (2013) Surgical techniques to minimize shoulder pain after laparoscopic cholecystectomy. A systematic review. Surg Endosc 27:2275–2282
Gurusamy KS, Samraj K, Davidson BR (2009) Low pressure versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy. Cochrane Database Syst Rev 15:CD006930. doi:10.1002/14651858.CD006930.pub2
Esmat ME, Elsebae MM, Nasr MM, Elsebaie SB (2006) Combined low pressure pneumoperitoneum and intraperitoneal infusion of normal saline for reducing shoulder tip pain following laparoscopic cholecystectomy. World J Surg 30:1969–1973
Beqiri AI, Domi RQ, Sula HH, Zaimi EQ, Petrela EY (2012) The combination of infiltrative bupivacaine with low-pressure laparoscopy reduces postcholecystectomy pain. A prospective randomized controlled study. Saudi Med J 33:134–138
Yasir M, Mehta KS, Banday VH, Aiman A, Masood I, Iqbal B (2012) Evaluation of post operative shoulder tip pain in low pressure versus standard pressure pneumoperitoneum during laparoscopic cholecystectomy. Surgeon 10:71–74
Perrakis E, Vezakis A, Velimezis G, Savanis G, Deverakis S, Antoniades J, Sagkana E (2003) Randomized comparison between different insufflation pressures for laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech 13:245–249
Ibraheim OA, Samarkandi AH, Alshehry H, Faden A, Farouk EO (2006) Lactate and acid base changes during laparoscopic cholecystectomy. Middle East J Anaesthesiol 18:757–768
Chok KS, Yuen WK, Lau H, Fan ST (2006) Prospective randomized trial on low-pressure versus standard-pressure pneumoperitoneum in outpatient laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech 16:383–386
Sandhu T, Yamada S, Ariyakachon V, Chakrabandhu T, Chongruksut W, Ko-iam W (2009) Low-pressure pneumoperitoneum versus standard pneumoperitoneum in laparoscopic cholecystectomy, a prospective randomized clinical trial. Surg Endosc 23:1044–1047
Kanwer DB, Kaman L, Nedounsejiane M, Medhi B, Verma GR, Bala I (2009) Comparative study of low pressure versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy–a randomised controlled trial. Trop Gastroenterol 30:171–174
Hua J, Gong J, Yao L, Zhou B, Song Z (2014) Low-pressure versus standard-pressure pneumoperitoneum for laparoscopic cholecystectomy: a systematic review and meta-analysis. Am J Surg 208:143–150
Gurusamy KS, Vaughan J, Davidson BR (2014) Low pressure versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy. Cochrane Database Syst Rev 3:CD006930. doi:10.1002/14651858.CD006930.pub3
Vijayaraghavan N, Sistla SC, Kundra P, Ananthanarayan PH, Karthikeyan VS, Ali SM, Sasi SP, Vikram K (2014) Comparison of standard-pressure and low-pressure pneumoperitoneum in laparoscopic cholecystectomy: a double blinded randomized controlled study. Surg Laparosc Endosc Percutan Tech 24:127–133
Bogani G, Uccella S, Cromi A, Serati M, Casarin J, Pinelli C, Ghezzi F (2014) Low vs standard pneumoperitoneum pressure during laparoscopic hysterectomy: prospective randomized trial. J Minim Invasive Gynecol 21:466–471
Barczyński M, Herman RM (2003) A prospective randomized trial on comparison of low-pressure (LP) and standard-pressure (SP) pneumoperitoneum for laparoscopic cholecystectomy. Surg Endosc 17:533–538
Fredman B, Jedeikin R, Olsfanger D, Flor P, Gruzman A (1994) Residual pneumoperitoneum: a cause of postoperative pain after laparoscopic cholecystectomy. Anesth Analg 79:152–154
Sabzi Sarvestani A, Zamiri M (2014) Residual pneumoperitoneum volume and postlaparoscopic cholecystectomy pain. Anesth Pain Med 4:e17366
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosure
Hemanga Bhattacharjee, AzarudeenJalaludeen, Virinder Bansal, Asuri Krishna, Subodh Kumar, Rajeshwari Subramaniam, Rashmi Ramachandranand Mahesh Misra have no conflicts of interest or financial ties to disclose.
Rights and permissions
About this article
Cite this article
Bhattacharjee, H.K., Jalaludeen, A., Bansal, V. et al. Impact of standard-pressure and low-pressure pneumoperitoneum on shoulder pain following laparoscopic cholecystectomy: a randomised controlled trial. Surg Endosc 31, 1287–1295 (2017). https://doi.org/10.1007/s00464-016-5108-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-016-5108-2