Abstract
Background
Laparoscopic surgery is the main trend method in a variety of surgical fields. Post-operative shoulder pain remains a bothersome issue although many surgical techniques have been applied to minimize it. A simple novel approach to reduce shoulder pain without adverse effects during and after laparoscopic surgery is desired.
Methods
This prospective randomized controlled study was conducted to enroll a total of 140 patients to evaluate the efficacy of low flow rate (1 L/min) for induction followed by high flow rate (10 L/min) for maintaining 12 mmHg pneumoperitoneum (group A, n = 70) during laparoscopic cholecystectomy (LC), compared to the continuous high flow rate group (group B, n = 70) in postoperative shoulder pain and other clinical features. The 10-visual analog scale (VAS) was applied for the severity of shoulder pain and scores were obtained at 1, 6, 12, 24, and 48 h after LC.
Results
There was no obvious difference in baseline characteristics as well as operative time, occurrence of bradycardia, or hospital stay between groups. The incidence of shoulder pain was not significantly different (group A 45.7% vs group B 48.6%, p = 0.866). However, the patients in group A with shoulder pain reported significantly less pain scores (p < 0.001) at 12 and 24 h after surgery, compared with those in group B.
Conclusions
Applying the strategy of low flow rate to induce pneumoperitoneum followed by high flow rate to maintain the pressure provides advantages to reduce the severity of shoulder pain for patients who underwent LC and then experienced shoulder pain.
Similar content being viewed by others
References
Buia A, Stockhausen F, Hanisch E. Laparoscopic surgery: A qualified systematic review. World J Methodol. 2015;5(4):238–54. doi:https://doi.org/10.5662/wjm.v5.i4.238.
Harrell AG, Heniford BT. Minimally invasive abdominal surgery: lux et veritas past, present, and future. Am J Surg. 2005;190(2):239–43. doi:https://doi.org/10.1016/j.amjsurg.2005.05.019.
Himal HS. Minimally invasive (laparoscopic) surgery. Surg Endosc. 2002;16(12):1647–52. doi:https://doi.org/10.1007/s00464-001-8275-7.
Kandil TS, El Hefnawy E. Shoulder pain following laparoscopic cholecystectomy: factors affecting the incidence and severity. J Laparoendosc Adv Surg Tech A. 2010;20(8):677–82. doi:https://doi.org/10.1089/lap.2010.0112.
Donatsky AM, Bjerrum F, Gogenur I. Surgical techniques to minimize shoulder pain after laparoscopic cholecystectomy. A systematic review. Surg Endosc. 2013;27(7):2275–82. doi:https://doi.org/10.1007/s00464-012-2759-5.
Slim K, Pezet D, Stencl J, Jr., Lechner C, Le Roux S, Lointier P et al. Laparoscopic cholecystectomy: an original three-trocar technique. World J Surg. 1995;19(3):394–7.
Strasberg SM, Hertl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg. 1995;180(1):101–25.
Roumm AR, Pizzi L, Goldfarb NI, Cohn H. Minimally invasive: minimally reimbursed? An examination of six laparoscopic surgical procedures. Surg Innov. 2005;12(3):261–87. doi:https://doi.org/10.1177/155335060501200313.
Sandhu T, Yamada S, Ariyakachon V, Chakrabandhu T, Chongruksut W, Ko-iam W. Low-pressure pneumoperitoneum versus standard pneumoperitoneum in laparoscopic cholecystectomy, a prospective randomized clinical trial. Surg Endosc. 2009;23(5):1044–7. doi:https://doi.org/10.1007/s00464-008-0119-2.
Tsimoyiannis EC, Siakas P, Tassis A, Lekkas ET, Tzourou H, Kambili M. Intraperitoneal normal saline infusion for postoperative pain after laparoscopic cholecystectomy. World J Surg. 1998;22(8):824–8.
Nyerges A. Pain Mechanisms in Laparoscopic Surgery. Semin Laparosc Surg. 1994;1(4):215–8. doi:https://doi.org/10.1053/SLAS00100215.
Nursal TZ, Yildirim S, Tarim A, Noyan T, Poyraz P, Tuna N et al. Effect of drainage on postoperative nausea, vomiting, and pain after laparoscopic cholecystectomy. Langenbecks Arch Surg. 2003;388(2):95–100. doi:https://doi.org/10.1007/s00423-003-0374-6.
Hawasli A, Brown E. The effect of drains in laparoscopic cholecystectomy. J Laparoendosc Surg. 1994;4(6):393–8.
Lindgren L, Koivusalo AM, Kellokumpu I. Conventional pneumoperitoneum compared with abdominal wall lift for laparoscopic cholecystectomy. Br J Anaesth. 1995;75(5):567–72.
Koivusalo AM, Kellokumpu I, Lindgren L. Gasless laparoscopic cholecystectomy: comparison of postoperative recovery with conventional technique. Br J Anaesth. 1996;77(5):576–80.
Barczynski M, Herman RM. A prospective randomized trial on comparison of low-pressure (LP) and standard-pressure (SP) pneumoperitoneum for laparoscopic cholecystectomy. Surg Endosc. 2003;17(4):533–8. doi:https://doi.org/10.1007/s00464-002-9121-2.
Gurusamy KS, Samraj K, Davidson BR. Low pressure versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy. Cochrane Database Syst Rev. 2009(2):CD006930. doi:https://doi.org/10.1002/14651858.CD006930.pub2.
Yasir M, Mehta KS, Banday VH, Aiman A, Masood I, Iqbal B. Evaluation of post operative shoulder tip pain in low pressure versus standard pressure pneumoperitoneum during laparoscopic cholecystectomy. Surgeon. 2012;10(2):71–4. doi:https://doi.org/10.1016/j.surge.2011.02.003.
Jorgensen JO, Gillies RB, Hunt DR, Caplehorn JR, Lumley T. A simple and effective way to reduce postoperative pain after laparoscopic cholecystectomy. Aust N Z J Surg. 1995;65(7):466–9.
Atak I, Ozbagriacik M, Akinci OF, Bildik N, Subasi IE, Ozdemir M et al. Active gas aspiration to reduce pain after laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech. 2011;21(2):98–100. doi:https://doi.org/10.1097/SLE.0b013e318213c301.
Uchiyama K, Tani M, Kawai M, Terasawa H, Hama T, Yamaue H. Clinical significance of drainage tube insertion in laparoscopic cholecystectomy: a prospective randomized controlled trial. J Hepatobiliary Pancreat Surg. 2007;14(6):551–6. doi:https://doi.org/10.1007/s00534-007-1221-x.
Aitola P, Airo I, Kaukinen S, Ylitalo P. Comparison of N2O and CO2 pneumoperitoneums during laparoscopic cholecystectomy with special reference to postoperative pain. Surg Laparosc Endosc. 1998;8(2):140–4.
Daskalakis M, Scheffel O, Weiner RA. High flow insufflation for the maintenance of the pneumoperitoneum during bariatric surgery. Obes Facts. 2009;2 Suppl 1:37–40. doi:https://doi.org/10.1159/000198252.
Berberoglu M, Dilek ON, Ercan F, Kati I, Ozmen M. The effect of CO2 insufflation rate on the postlaparoscopic shoulder pain. J Laparoendosc Adv Surg Tech A. 1998;8(5):273–7. doi:https://doi.org/10.1089/lap.1998.8.273.
Author information
Authors and Affiliations
Contributions
1. Critical revision of the manuscript for important intellectual content: De-Chuan Chan, Cheng-Jueng Chen, and Jyh-Cherng Yu
2. Material support: Teng-Wei Chen, Chung-Bao Hsieh, and De-Chuan Chan
3. Study concept and design and analysis and interpretation of data, drafting of the manuscript, statistical analysis, and writing: Kuo-Feng Hsu, Si-Yuan Wu, Bao-Chung Chen, and Chih-Wei Yang
Corresponding authors
Ethics declarations
All patients (64 men and 76 women) between 19 and 84 years of age (mean age, 56.9 years) were blinded and randomly divided into low flow rate (1 L/min) for induction followed by high flow rate (10 L/min) for maintaining 12 mmHg pneumoperitoneum (group A, n = 70) and the continuous high flow rate group (group B, n = 70) by computer-based sequential allocation.
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Hsu, KF., Chen, CJ., Yu, JC. et al. A Novel Strategy of Laparoscopic Insufflation Rate Improving Shoulder Pain: Prospective Randomized Study. J Gastrointest Surg 23, 2049–2053 (2019). https://doi.org/10.1007/s11605-018-3896-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11605-018-3896-5