Abstract
Background:
We designed a prospective randomized clinical trial to investigate whether intraperitoneal saline washout combined with a low-pressure pneumoperitoneum (LPSW) was superior to low-pressure pneumoperitoneum (LP) alone as a means of reducing postoperative pain and analgesic consumption in the early recovery period after laparoscopic cholecystectomy (LC).
Methods:
A total of 124 consecutive patients undergoing LC due to uncomplicated symptomatic gallstones were randomized to the LP or LPSW group. In the LPSW group, normal saline at body temperature (25 ml/kg of body weight) was irrigated under the diaphragm. The fluid was evacuated via the passive-flow method through a 16-F closed drain left under the liver for 24 h. We then assessed the intensity of total abdominal postoperative pain using the Visual Analogue Scale (VAS), including the incidence of shoulder-tip pain (STP), total daily analgesia demand rate, analgesic consumption. Quality of life (QOL) within 7 days after the operation was assessed using the Medical Outcomes Study Short Form 36 Health Survey (SF-36). A p value of <0.05 was considered significant.
Results:
The mean postoperative pain score was lower by 2.64 ± 0.86 in the LPSW; the difference equaled 9.64% (p < 0.05). The incidence of STP was lower in the LPSW group (LP 11.29% vs LPSW 1.6%; p = 0.028). The analgesia demand rate was remarkably lower in LPSW vs LP within 24 and 48 h postoperatively (70.96% vs 90.32%; p = 0.006 and 64.51% vs. 83.87%; p = 0.013, respectively). After LPSW vs LP, QOL was better in terms of physical functioning, role limitations due to physical problems, and bodily pain (90.32% vs 77.42%; p = 0.05, 90.32% vs 75.8%; p = 0.03, 91.93% vs 74.19%; p = 0.008, respectively).
Conclusion:
In terms of lower postoperative pain and a better QOL within the early recovery period, LPSW is superior to LP alone. The saline washout procedure should be recommended during LC because it is a simple way to reduce pain intensity, even after LP operations.
Similar content being viewed by others
References
A Alijani A Cuschieri (2001) ArticleTitleAbdominal wall lift systems in laparoscopic surgery: gasless and low-pressure systems Semin Laparosc Surg 8 53–62
D Bala D Shields S Shukri (2001) ArticleTitleProspective randomized trial of low-pressure pneumoperitoneum for reduction of shoulder-tip pain following laparoscopy Br J Surg 88 315
M Barczyński RM Herman (2003) ArticleTitleA prospective randomized trial on comparison of low-pressure (LP) and standard-pressure (SP) pneumoperitoneum for laparoscopic cholecystectomy Surg Endosc 17 533–538
MG Cunniffe OJ McAnena MA Dar J Calleary N Flynn (1998) ArticleTitleA prospective randomized trial of intraoperative bupivacaine irrigation for management of shoulder-tip pain following laparoscopy Am J Surg 176 258–261
D Davides K Birbas A Vezakis MJ McMahon (1999) ArticleTitleRoutine low-pressure pneumoperitoneum during laparoscopic cholecystectomy Surg Endosc 13 887–889
SPL Dexter M Vucevic J Gibson MJ McMahon (1995) ArticleTitlePreservation of hemodynamic function by low-pressure laparoscopic cholecystectomy Surg Endosc 9 600
SP Dexter M Vucevic J Gibson MJ McMahon (1999) ArticleTitleHemodynamic consequences of high- and low-pressure capnoperitoneum during laparoscopic cholecystectomy Surg Endosc 13 376–381
BA Elfberg S Sjovall-Mjoberg (2000) ArticleTitleIntraperitoneal bupivacaine does not effectively reduce pain after laparoscopic cholecystectomy: a randomized, placebo-controlled and double-blind study . 10 357–359
SJ Fletcher (2000) ArticleTitleHemodynamic consequences of high- and low-pressure capnoperitoneum during laparoscopic cholecystectomy Surg Endosc 14 596
AM Koivusalo I Kellokumpu L Lindgren (1997) ArticleTitlePostoperative drowsiness and emetic sequelae correlate to total amount of carbon dioxide used during laparoscopic cholecystectomy . 11 42–44
J Neudecker S Sauerland E Neugebauer R Begamaschi HJ Bonjer A Cuschieri KH Fuchs et al. (2001) ArticleTitleThe European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery Surg Endosc 16 1121–1143
CJO O’Boyle AC deBeaux DI Watson R Ackroyd T Lafullarde JY Leong JAR Williams et al. (2002) ArticleTitleHelium vs carbon dioxide gas insufflation with or without saline lavage during laparoscopy: a randomized trial Surg Endosc 16 620–625
E Perrakis A Vezakis G Velimezis G Savanis S Deverakis J Antoniades E Sagkana (2003) ArticleTitleRandomized comparison between different insufflation pressures for laparoscopic cholecystectomy Surg Laparosc Endosc Percutan Tech 13 245–249
L Sarli R Costi G Sansebastiano M Trivelli L Roncoroni (2000) ArticleTitleProspective randomized trial of low-pressure pneumoperitoneum for reduction of shoulder-tip pain following laparoscopy Br J Surg 87 1161–1165
MK Schilling C Redaelli L Krahenbuhl C Signer MW Buchler (1997) ArticleTitleSplanchnic microcirculatory changes during CO2 laparoscopy J Am Coll Surg 184 378–382
JW Szem L Hydo PS Barie (1996) ArticleTitleA double-blinded evaluation of intraperitoneal bupivacaine vs saline for the reduction of postoperative pain and nausea after laparoscopic cholecystectomy Surg Endosc 10 44–48 Occurrence Handle10.1007/s004649910011 Occurrence Handle1:STN:280:BymB28znvVc%3D Occurrence Handle8711605
EC Tsimoyiannis P Siakas A Tassis ET Lekkas H Tzourou M Kambili (1998) ArticleTitleIntraperitoneal normal saline infusion for postoperative pain after laparoscopic cholecystectomy World J Surg 22 824–828
EC Tsimoyiannis G Glantzounis ET Lekkas P Siakas M Jabardin H Tzourou (1998) ArticleTitleIntraperitoneal normal saline and bupivacaine infusion for reduction of postoperative pain after laparoscopic cholecystectomy Surg Laparosc Endosc 8 416–420 Occurrence Handle10.1097/00019509-199812000-00003 Occurrence Handle1:STN:280:DyaK1M%2FnvFyisg%3D%3D Occurrence Handle9864106
A Vezakis D Davides JS Gibson MR Moore H Shah M Larvin MJ McMahon (1999) ArticleTitleRandomized comparison between low-pressure laparoscopic cholecystectomy and gasless laparoscopic cholecystectomy Surg Endosc 13 890–893
DH Wallace MG Serpell JN Baxter PJ O’Dwyer (1997) ArticleTitleRandomized trial of different insufflation pressure for laparoscopic cholecystectomy Br J Surg 84 455–458
JE Ware D Sherbourne (1992) ArticleTitleThe MOS 36-Item Short-Form Health Survey (SF-36) Med Care 30 473–483 Occurrence Handle1593914
VL Wills DR Hunt (2000) ArticleTitlePain after laparoscopic cholecystectomy Br J Surg 87 273–284
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Barczyński, M., Herman, R.M. Low-pressure pneumoperitoneum combined with intraperitoneal saline washout for reduction of pain after laparoscopic cholecystectomy: a prospective randomized study. Surg Endosc 18, 1368–1373 (2004). https://doi.org/10.1007/s00464-003-9299-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-003-9299-y