Comparison of Preoperative Oral Acetazolamide and Intraperitoneal Normal Saline Irrigation for Reduction of Postoperative Pain After Laparoscopic Cholecystectomy

Abstract

Visceral and shoulder tip pain following laparoscopic cholecystectomy is mainly due to carbon dioxide (CO2) insufflation. Various methods have been adopted to eliminate residual CO2. We compared the postoperative analgesic efficacy of intraperitoneal normal saline (30 mL/kg) irrigation with preoperative oral acetazolamide administration in patients undergoing laparoscopic cholecystectomy. Sixty patients between 20 and 60 years of age were included in this prospective, randomized, double-blind study. Patients in Group I received placebo, Group II patients received preoperative oral acetazolamide (5 mg/kg), and Group III patients received intraperitoneal irrigation with 30 mL/kg of normal saline. Intravenous paracetamol (1 g) was administered every 6 hours for postoperative analgesia. Parietal and visceral pain scores at rest, on movement, and on coughing and shoulder tip pain were recorded using a visual analog scale after arrival in the postanesthesia care unit, at 1, 2, 4, 6, 12, and 24 hours after surgery. Rescue analgesia was provided with an intravenous fentanyl (1 μg/kg) bolus whenever the visual analog scale score was ≥4. Compared with Group I, Group III patients had significantly lower visceral pain scores at all time intervals except at 12 hours. Group III patients also recorded significantly lower visceral pain scores than Group II from 2 to 24 hours. There was no significant difference in shoulder tip pain. The total dose of fentanyl used was significantly less in Group III. Intraperitoneal normal saline irrigation is more effective than acetazolamide in reducing postoperative visceral pain after laparoscopic cholecystectomy and has significant opioid-sparing effect. However, its effect on shoulder pain is comparable to that of acetazolamide.