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Combined Low Pressure Pneumoperitoneum and Intraperitoneal Infusion of Normal Saline for Reducing Shoulder Tip Pain Following Laparoscopic Cholecystectomy

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Abstract

Introduction

Intraabdominal CO2 gas after laparoscopic cholecystectomy causes postoperative shoulder-tip pain. Many methods of analgesia have been used to reduce this pain, including analgesic drugs, intraperitoneal local anesthetic, intraperitoneal saline, a gas drain, heated gas, low-pressure gas, and nitrous oxide pneumoperitoneum. The aim of this study was to evaluate the efficacy of combined low-pressure CO2 pneumoperitoneum and intraperitoneal infusion of normal saline in reducing the incidence of postoperative shoulder-tip pain.

Methods

Altogether, 109 patients undergoing elective laparoscopic cholecystectomy were randomized prospectively into three groups. Patients in group A (n = 34) underwent laparoscopic cholecystectomy with 14 mmHg CO2 pneumoperitoneum; patients in group B (n = 37) underwent laparoscopic cholecystectomy with 10 mmHg CO2 pneumoperitoneum; and those in group C (n = 38) underwent laparoscopic cholecystectomy with 10 mmHg CO2 pneumoperitoneum in addition to intraperitoneal normal saline infusion in the right hemidiaphragmatic area. Shoulder-tip pain was recorded on a verbal rating scale 2, 6, 12, 24, and 48 hours after operation.

Results

Twelve patients in group A (35.2 percent), six in group B (16.2 percent), and seven in group C (18.4 percent) complained of shoulder-tip pain. Hence, there was a significant decrease in the frequency of shoulder-tip pain in groups B and C in relation to group A, but there was no significant difference between groups B and C. The postoperative shoulder-tip pain scores were significantly reduced in group C at 6, 12, and 24 hours. The number of patients who required additional analgesics was also reduced in group C.

Conclusions

Low-pressure CO2 pneumoperitoneum reduces the number of patients complaining of shoulder-tip pain and the intensity of the pain after laparoscopic cholecystectomy. The addition of intraperitoneal normal saline infusion to low-pressure CO2 pneumoperitoneum seems to reduce the intensity but not the frequency of shoulder-tip pain after laparoscopic cholecystectomy.

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References

  1. Berggren, Gordh T, Grama D, et al. Laparoscopy versus open cholecystectomy: hospitalization, sick leave, analgesia and trauma responses. Surgery 1994;81:1362–1365

  2. Joris J, Thiry E, Paris P, et al. Pain after laparoscopic cholecystectomy: characteristics and effect of intraperitoneal bupivacaine. Anesth Analg 1995;81:379–384

    Article  PubMed  CAS  Google Scholar 

  3. Alberto P, Verena D, Riccardo C, et al. Pre-emptive analgesia: intraperitoneal local anaesthetic in laparoscopic cholecystectomy. Anesthesiology 1996;85:11–20

    Google Scholar 

  4. Lindgren L. Pain after laparoscopic cholecystectomy: do we do our best? Acta Anaesthesiol Scand 1997;41:191–192

    PubMed  CAS  Google Scholar 

  5. Narchi P, Benhamou D, Femandez H. Intraperitoneal local anaesthetic pain relief after day case laparoscopy. Lancet 1991;338:1569–1570

    Article  PubMed  CAS  Google Scholar 

  6. Fredmann B, Jedeikin R, Olsfanger D, et al. Residual pneumoperitoneum: a cause of postoperative pain after laparoscopic cholecystectomy. Anesth Analg 1994;79:152–154

    Google Scholar 

  7. Zucker KA, Bailey RW, Gadacz TR, et al. Laparoscopic guided cholecystectomy. Am J Surg 1991;161:36–44.

    Article  PubMed  CAS  Google Scholar 

  8. Mraovic B, Jurisic T, Kogler-Majeric V, et al. Intraperitoneal bupivacaine for analgesia after laparoscopic cholecystectomy. Acta Anaesthesiol Scand 1997;41:193–196

    PubMed  CAS  Google Scholar 

  9. Rosenblum M, Weller RS, Conard P, et al. Ibuprofen provides longer lasting analgesia than fentanyl after laparoscopic surgery. Anesth Analg 1991;73:255–259

    Article  PubMed  CAS  Google Scholar 

  10. Joris J, Cigarini I, Legrand M et al. Metabolic and respiratory changes after cholecystectomy performed via laparotomy or laparoscopy. Br J Anaesth 1992;69:341–345

    PubMed  CAS  Google Scholar 

  11. Nyerges A. Pain mechanisms in laparoscopic surgery. Semin Laparosc Surg 1994;1:215–218

    PubMed  Google Scholar 

  12. Wallace DH, Serpell MG, Baxter JN, et al. Randomized trial of different insufflation pressures for laparoscopic cholecystectomy. Br J Surg 1997;84:455–458

    Article  PubMed  CAS  Google Scholar 

  13. Schoeffler P, Diemunsch P, Fourgeaud L. Coelioscopie ambulatoire. Cah Anesthesiol 1993;41:385–391

    PubMed  CAS  Google Scholar 

  14. Riedel HH, Semm K. Das postpelviskopische (laparoscopische) Schmerzsyndrom. Geburtshilfe Frauenheilkd 1980;40:635–643

    Article  PubMed  CAS  Google Scholar 

  15. Dobbs FF, Kumar V, Alexandar JI, et al. Pain after laparoscopy related to posture and ring versus clip sterilization. Br J Obstet Gynaecol 1987;94:262–266

    PubMed  CAS  Google Scholar 

  16. McMahon AJ, Russell IT, Ramsay G, et al. Laparoscopic and minilaparotomy cholecystectomy: a randomised trial comparing postoperative pain and pulmonary function. Surgery 1994;15:533–539

    Google Scholar 

  17. Jackson SA, laurence AS, Hill JC. Does post-laparoscopy pain related to residual carbon dioxide? Anaesthesia 1996;51:485–487

    PubMed  CAS  Google Scholar 

  18. Kissin I. Preemptive analgesia: why its effect is not always obvious. Anesthesiology 1996;84:1015–1019

    Article  PubMed  CAS  Google Scholar 

  19. Helvacioglu A, Weis R. Operative laparoscopy and postoperative pain relief. Fertil Steril 1992;57:548–452

    PubMed  CAS  Google Scholar 

  20. Tsimoyiannis EC, Glantzounis G, Lekkas ET, et al. Intraperitoneal normal saline and bupivacaine infusion for reduction of postoperative pain after laparoscopic cholecystectomy. Surg Laparosc Endosc 1998;8:416–420.

    Article  PubMed  CAS  Google Scholar 

  21. Abdel Razek E. Intraperitoneal levobupivacaine for analgesia after laparoscopic cholecystectomy. Egypt J Anaesth 2003;19:249–254

    Google Scholar 

  22. Korell M, Schmaus F, Strowitzki T, et al. Pain intensity following laparoscopy. Surg Laparosc Endosc 1996;6:375–379

    Article  PubMed  CAS  Google Scholar 

  23. Alexander JI, Hull MG. Abdominal pain after laparoscopy: the value of a gas drain. Br J Obstet Gynaecol 1987;94:267–269

    PubMed  CAS  Google Scholar 

  24. Aitola P, Airo I, Kaukinen S, et al. Comparison of N2O and CO2 pneumoperitoneum during laparoscopic cholecystectomy with special reference to postoperative pain. Surg Laparosc Endosc 1998;8:140–144

    Article  PubMed  CAS  Google Scholar 

  25. Sarli L, Costi R, Sansebastiano G, et al. Prospective randomized trial of low-pressure pneumoperitoneum for reduction of shoulder-tip pain following laparoscopy. Br J Surg 2000;87:1161–1165

    Article  PubMed  CAS  Google Scholar 

  26. Lodhi FB, Hussain R. Laparoscopic cholecystectomy: low-pressure pneumoperitoneum for shoulder-tip pain. Professional Med J 2003;10:266–270

    Google Scholar 

  27. Barczynski M, Herman RM. A prospective randomized trail on comparison of low-pressure (LP) and standard-pressure (SP) pneumoperitoneum for laparoscopic cholecystectomy. Surg Endosc 2003;17:533–538

    Article  PubMed  CAS  Google Scholar 

  28. Huang ML, Chao C, Mong FY, et al. Intraperitoneal infusion of normal saline to reduce postoperative pain in patients receiving laparoscopic cholecystectomy: experience in MTYH. J Med Sci 2001;21:273–276

    Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Theodor Bilharz Research Institute, Kornish el Nile, Warak, Imbaba, PO Box 30, Giza, Cairo, 12411, Egypt

    M. Emad Esmat FRCS (Glasgow) MD, Magdy M.A. Elsebae MD, Magid M.A. Nasr MD & Sameh B. Elsebaie MD

  2. 31 Cedarhurst, Harborne, Birmingham, B32 2JZ, UK

    M. Emad Esmat FRCS (Glasgow) MD

Authors
  1. M. Emad Esmat FRCS (Glasgow) MD
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  2. Magdy M.A. Elsebae MD
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  3. Magid M.A. Nasr MD
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  4. Sameh B. Elsebaie MD
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Correspondence to M. Emad Esmat FRCS (Glasgow) MD.

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Esmat, M.E., Elsebae, M.M., Nasr, M.M. et al. Combined Low Pressure Pneumoperitoneum and Intraperitoneal Infusion of Normal Saline for Reducing Shoulder Tip Pain Following Laparoscopic Cholecystectomy. World J. Surg. 30, 1969–1973 (2006). https://doi.org/10.1007/s00268-005-0752-z

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  • DOI: https://doi.org/10.1007/s00268-005-0752-z

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