Page 15 - World Journal of Laparoscopic Surgery

WJOLS
WJOLS

10.5005/jp-journals-10033-1238
Prospective Randomized Trial of Low Pressure Pneumo peritoneum for Reduction of Shoulder Tip Pain
OriginaL articLe

Prospective Randomized Trial of Low Pressure Pneumo­

peritoneum for Reduction of Shoulder Tip Pain following
Laparoscopic Cholecystectomy: A Comparative Study

2
1 Muzzafar Zaman, Kunal Chowdhary, Pradeep Goyal
3
ABSTRACT This study also shows that low pressure technique is safe with
comparable rate of intraoperative complications.
Background: Abdominal pain and shoulder tip pain after
laparoscopic cholecystectomy are distressing for the patient. Keywords: laparoscopic cholecystectomy, low pressure
Various causes of this pain are peritoneal stretching and pneumoperitoneum, Shoulder tip pain.
diaphragmatic irritation by high intra-abdominal pressure How to cite this article: Zaman M, Chowdhary K, Goyal p.
caused by pneumoperitoneum. We designed a study to com- prospective Randomized Trial of low pressure pneumo-
pare the postoperative pain after laparoscopic cholecystectomy peritoneum for Reduction of Shoulder Tip pain following lapa-
at low pressure (7-8 mm Hg) and standard pressure technique roscopic Cholecystectomy: A Comparative Study. World J lap
(12-14 mm Hg). Surg 2015;8(1):13-15.
Aim: To compare the effect of low pressure and standard Source of support: Nil
pre ssure pneumoperitoneum in post-laparoscopic cholecys- Conflict of interest: None
tectomy pain. Further to study, the safety of low pressure
pneumoperitoneum in laparoscopic cholecystectomy.
inTRoduCTion
Settings and design: A prospective randomized double
blind study. Carbon dioxide is the commonest means of achieving
Materials and methods: A prospective randomized double pneumoperitoneum in modern minimal access surgery
blind study was done in 50 ASA grade I and II patients. They worldwide and it is the same gas responsible for postope­
were divided into two groups—25 each. Group A, patients rative shoulder tip pain. The reported incidence of shoul­
underwent laparoscopic cholecystectomy with low pressure
pneumoperitoneum (7-8 mm Hg) while group B, underwent der tip pain following laparoscopic cholecystectomy is
1,2
laparoscopic cholecystectomy with standard pressure pneu- 30 to 50%. Carbon dioxide is used for insufflations as it
moperitoneum (12-14 mm Hg). Both the groups were compared is 200 times more diffusible than oxygen, rapidly cleared
for pain intensity, analgesic requirement and complications. by the lungs and does not support the combustion.
Shoulder tip pain was recorded on a visual analog pain scale
1, 6, 12, 24 and 48 hours after operation. Carbon dioxide when comes in contact with peritoneal fluid
converts into carbonic acid which irritates diaphragm
Statistical analysis: Demographic data and intraoperative
complications were analyzed using Chi-square test. Frequency causing shoulder tip pain and discomfort in abdomen.
of pain, intensity of pain, analgesics consumption and other
pneumoperitoneum related complications were compared by AiMS And oBJECTiVES
applying ANOVA test.
The aim of this study is to see whether low pressure
Results: Postoperative pain score was significantly less in low (10 mm Hg) laparoscopic cholecystectomy can be consi­
pressure group as compared to standard pressure group. Num-
ber of patients requiring rescue analgesic doses was more in dered as the standard technique for uncomplicated
standard pressure group. This was statistically significant. Also symptomatic gall stone disease.
total analgesic consumption was more in standard pressure
group. There was no difference in intraoperative complications. MATERiALS And METHodS
Conclusion: This study demonstrates the use of simple expe- The study was carried out in the department of general
dient of reducing the pressure of pneumoperitoneum to 8 mm surgery, MMU Medical College and Hospital, solan,
results in reduction in both intensity and frequency of post-
operative pain, and hence early recovery and better outcome. from July 2014 to March 2015.
inclusion Criteria

1,3 Assistant professor, Senior Resident • Age 18 to 60 years
2
1-3 Department of General Surgery, MMU Medical College and • Cholelithiasis (uncomplicated).
Hospital, Solan, Himachal pradesh, India
Exclusion Criteria
Corresponding Author: Muzzafar Zaman, Assistant
professor, Department of General Surgery, MMU Medical • Acute cholecystitis
College and Hospital, Kumarhatti, Solan-173229, Himachal • Age < 18 and > 60
pradesh, India, e-mail: muzzafarzaman@yahoo.com
• Pregnancy.
World Journal of Laparoscopic Surgery, January-April 2015;8(1):13-15 13