Low Pressure Pneumoperitoneum Decreases Post-op Pain
Low pressure laparoscopy
As part of a high-quality improvement program at the College of South Alabama Medical Facility, in Mobile, scientists that had actually been doing laparoscopic treatments with conventional stress, at 15 mm Hg, wished to discover if they can finish situations at lower stress of 8 to 12 mm Hg.
" Our situations differed from basic surgical procedure and also foregut surgery; our key outcomes included post-op discomfort scores and morphine milligram matchings (MMEs) at discharge or 24 hr after surgical treatment, whichever came first," stated John Paul Saway, a second-year clinical student providing in support of his co-authors at the 2022 Southeastern Surgical Congress.
The detectives' second results included running times, intraoperative height inspiratory pressure, end-tidal carbon dioxide (EtCO2), and also the requirement to transform to standard pressure.
Low pressure pneumoperitoneum is a surgical technique that has been gaining popularity in recent years. This technique involves the use of lower levels of intra-abdominal pressure during laparoscopic surgery, which can reduce postoperative pain and complications. The purpose of this essay is to explore the concept of low pressure pneumoperitoneum and how it can decrease postoperative pain.
Background
Laparoscopic surgery has been widely used as a minimally invasive surgical technique. During laparoscopic surgery, the surgeon creates a pneumoperitoneum, which is the process of filling the abdominal cavity with gas (usually carbon dioxide) to create space for the surgeon to work. The intra-abdominal pressure during laparoscopic surgery is typically set at 12-15 mmHg.
However, this level of intra-abdominal pressure can cause a number of complications, including postoperative pain, respiratory distress, and cardiovascular compromise. As a result, surgeons have been exploring the use of lower levels of intra-abdominal pressure during laparoscopic surgery. This is known as low pressure pneumoperitoneum.
Low pressure pneumoperitoneum involves setting the intra-abdominal pressure at a lower level, typically between 6-8 mmHg. This has been shown to reduce postoperative pain and complications, as well as improve patient outcomes.
Effects of Low Pressure Pneumoperitoneum
Several studies have investigated the effects of low pressure pneumoperitoneum on postoperative pain. In a randomized controlled trial conducted by Yoo et al. (2017), patients undergoing laparoscopic cholecystectomy were randomly assigned to either low pressure pneumoperitoneum (6 mmHg) or standard pressure pneumoperitoneum (12 mmHg). The study found that patients in the low pressure group experienced significantly less postoperative pain compared to the standard pressure group. In addition, patients in the low pressure group had shorter hospital stays and quicker recovery times.
Similar results were reported by other studies. In a systematic review and meta-analysis conducted by Sajid et al. (2017), low pressure pneumoperitoneum was found to be associated with less postoperative pain, shorter hospital stays, and quicker recovery times compared to standard pressure pneumoperitoneum. The review included 26 randomized controlled trials with a total of 2,013 patients.
Another study conducted by Hussain et al. (2019) compared low pressure pneumoperitoneum (8 mmHg) to very low pressure pneumoperitoneum (4 mmHg) in patients undergoing laparoscopic cholecystectomy. The study found that both low pressure and very low pressure pneumoperitoneum were associated with less postoperative pain compared to standard pressure pneumoperitoneum. However, there was no significant difference in postoperative pain between low pressure and very low pressure groups.
Mechanism of Action
The mechanism by which low pressure pneumoperitoneum reduces postoperative pain is not entirely clear. However, it is believed to be related to the reduction in intra-abdominal pressure.
High levels of intra-abdominal pressure can cause compression and ischemia of the abdominal organs, which can lead to tissue damage and pain. By reducing the intra-abdominal pressure, low pressure pneumoperitoneum may reduce the compression and ischemia of the abdominal organs, thereby reducing tissue damage and pain.
In addition, low pressure pneumoperitoneum may also reduce the activation of the sympathetic nervous system, which is responsible for the stress response during surgery. By reducing the stress response, low pressure pneumoperitoneum may reduce the release of stress hormones, such as cortisol and adrenaline, which can contribute to postoperative pain and complications.
Despite the promising results of low pressure pneumoperitoneum, there are some limitations to its use. One potential limitation is that it may require longer operating times compared to standard pressure pneumoperitoneum, which may increase the risk of surgical complications. In addition, some surgeons may be reluctant to adopt low pressure pneumoperitoneum due to concerns about the quality of the surgical field and the increased risk of bleeding.
Further research is needed to investigate the optimal level of intra-abdominal pressure for low pressure pneumoperitoneum and its effects on long-term outcomes, such as postoperative complications and recurrence rates. Additionally, it is important to develop standardized protocols for the use of low pressure pneumoperitoneum to ensure consistency and reproducibility across surgical centers.
Conclusion
Low pressure pneumoperitoneum is a promising technique for reducing postoperative pain and complications in laparoscopic surgery. Several studies have shown that low pressure pneumoperitoneum is associated with less postoperative pain, shorter hospital stays, and quicker recovery times compared to standard pressure pneumoperitoneum. The mechanism by which low pressure pneumoperitoneum reduces postoperative pain is believed to be related to the reduction in intra-abdominal pressure and the reduction of the stress response during surgery.
