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Association between intraabdominal pressure during gynaecologic laparoscopy and postoperative pain

  • General Gynecology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Laparoscopy is nowadays a well-established surgical method and plays a main role in an ever-increasing range of indications in gynaecology. High-quality studies of surgical techniques are necessary to improve the quality of patient care. The present study aims at evaluating postoperative pain after gynaecological laparoscopy depending on the intraoperative CO2 pressure.

Methods

In a prospective, monocentric, randomized single-blind study at the Department of Gynaecology and Obstetrics at the Hannover Medical School, we include patients scheduled for different laparoscopic procedures. Randomization of the intraoperative CO2 pressure was carried out in six groups. Pain was assessed the day after surgery by the blinded nurse using a visual analogue scale.

Results

550 patients were included in the period from May 2013 to January 2016. The analysis of the per protocol population PPP (n = 360) showed no statistically significant difference between the six intervention groups with regard to mean postoperative pain perception. In direct comparison between two groups, an intraoperative CO2 pressure of 15 mmHg was associated with a significant higher pain score than a pressure of 12 mmHg. The difference was 7.46 mm on a 10 cm VAS.

Conclusions

The results of our study indicate that a CO2 pressure of 12 versus 15 mmHg can be advantageous. However, the clinical relevance remains unclear due to the low difference in pain. The additional benefit of an even lower pressure of 10 or 8 mmHg cannot be reliably assessed; we found signs of poor visibility conditions in these low pressure groups.

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Author contribution

SK: Protocol and project development, data collection, data analysis, manuscript writing. CW: Data collection, data analysis, manuscript editing. Hermann Hertel: Data collection, manuscript editing. PH: Project development, Data collection, manuscript editing. RK: Data collection, data analysis, manuscript editing. PS: Protocol and project development, data collection, data analysis, manuscript editing.

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Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany

    Sudip Kundu, Clara Weiss, Hermann Hertel, Peter Hillemanns, Rüdiger Klapdor & Philipp Soergel

Authors
  1. Sudip Kundu
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  2. Clara Weiss
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  3. Hermann Hertel
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  4. Peter Hillemanns
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  5. Rüdiger Klapdor
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  6. Philipp Soergel
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Corresponding author

Correspondence to Sudip Kundu.

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Funding

This study was financed by own funds of our department.

Conflict of interest

We have no possible conflict of interest to mention. We certify that we have no affiliation with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the manuscript (e.g., employment, consultancies, stock ownership, honoraria).

This article does not contain any studies with animals performed by any of the authors. No animals were involved in this study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study prior to any study procedure.

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Kundu, S., Weiss, C., Hertel, H. et al. Association between intraabdominal pressure during gynaecologic laparoscopy and postoperative pain. Arch Gynecol Obstet 295, 1191–1199 (2017). https://doi.org/10.1007/s00404-017-4325-9

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  • DOI: https://doi.org/10.1007/s00404-017-4325-9

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