Postoperative Shoulder Tip Pain Research Articles

A randomised clinical trial to study postoperative abdominal and shoulder tip pain following low and standard pressure laparoscopic cholecystectomy

BackgroundLaparoscopic cholecystectomy (LC) has become the gold standard for the management of symptomatic gallstone disease. The complications related to different pressure ranges of pneumoperitoneum have been studied widely with no definite conclusion till date. The current study was planned to determine the effect of standard versus low pressure laparoscopic cholecystectomy (LPLC) on postoperative abdominal and shoulder tip pain (STP). MethodsThe present randomised clinical trial included 84 patients divided into two groups: standard pressure laparoscopic cholecystectomy (SPLC) (13 mmHg) and LPLC (9 mmHg). The variables tested were abdominal pain at 3, 6, 12 and 24 h (by verbal rating scale), the incidence and intensity of STP, post-operative nausea and vomiting (PONV) and surgeon's comfort for the two techniques. ResultsThe demographic characteristics of patients were similar in both groups. In LPP group, the postoperative abdominal pain at 6, 12 and 24 h was significantly less than SPLC; p = 0.02. Incidence of shoulder pain was significantly less in low pressure group (7.14%) compared with standard pressure (28.57%). ConclusionsLow-pressure pneumoperitoneum (LPP) is safe and feasible surgery with reduced abdominal and STP.

An observational study on the effect of high versus low carbon dioxide pressure in laparoscopic cholecystectomy

Background: Gall bladder stone is one of the common diseases of hepatobiliary system. If it is symptomatic then it needs to be treated and sometimes it may lead to multiple complications. Laparoscopic approach for cholecystectomy is widely acceptable and routinely done procedure for gall bladder stone. Laparoscopic cholecystectomy reduces postoperative pain and hospital stay as compared to open surgery. Laparoscopic surgeries require carbon dioxide (CO2) to inflate peritoneal cavity.Methods: It is an observational study at tertiary care centre. In present study authors have included all patients undergoing elective laparoscopic cholecystectomy. Patients required conversion to open cholecystectomy from laparoscopic cholecystectomy and emergency laparoscopic cholecystectomy and laparoscopic cholecystectomy for malignancy were not included. In present study, patients were randomly allocated into two groups: group A (n=50) low CO2 pressure (8-10 mmHg) pneumoperitonium and group B (n=50) high CO2 pressure (12-14 mmHg) pneumoperitonium to perform laparoscopic cholecystectomy. In present study authors have compared post operative effects in term of pain (at 4, 8 and 12 hrs post operatively), hospital stay and requirements of injectable analgesics between group A and group B.Results: 14 patients in group B complained of post operative shoulder tip pain as compared to only 5 patients in group A. Analgesic requirement and mean length of post operative hospital stay were also less in group A as compared to group B.Conclusions: Low pressure laparoscopic cholecystectomy (LPLC) significantly decrease the frequency and intensity of post operative shoulder tip pain. So, LPLC decrease the demand for postoperative analgesics and decrease post operative hospital stay.

To study the low-pressure pneumoperitoneum laparoscopic cholecystectomy

Aim: The aim of this study to determine the low-pressure pneumoperitoneum laparoscopic cholecystectomy.Materials and methods: This research comprised a total of 80 patients who were hospitalised for elective laparoscopic cholecystectomy. patients undergoing open cholecystectomy after conversion. The research did not include patients with acute inflammation or any other choledocholithiasis or gallstone-related complications. Every patient was asked for written informed permission after being told about the research.Results: The most prevalent presenting symptom (85%) was pain in the right upper quadrant. All of the patients had cholelithiasis confirmed by ultrasonography but no symptoms of inflammation. The majority of the patients (80%) had numerous gallbladder stones. The gallbladder was normal in 40 instances (50%), distended in 24 cases (30%), and constricted in 16 cases (20%) intraoperatively, cholesterosis was present in 10 cases (12.5%), and biliary sludge was found in 16 cases (20%). There were no severe intraoperative complications. There was no conversion to normal pressure laparoscopic cholecystectomy or open cholecystectomy. The average surgical time was 35.85±5.85 minutes. The visual analogue scale pain ratings for postoperative shoulder tip pain were 4.5±0.33, 2.4±0.12, and 0.22±0.04, respectively, at 5, 10, and 24 hours. In 91.25% of the patients, oral feeds were begun on the first postoperative day. On the 0th postoperative day, 95% of the patients were ambulating. The average length of stay after surgery was 1.2±0.51 days. On average 6 months of follow-up, no serious problems were notedConclusion: Experienced surgeons may safely use low-pressure pneumoperitoneum to perform laparoscopic cholecystectomy with a lower risk of early postoperative problems, such as shoulder tip discomfort. Only the lengthier learning curve holds it back from being optimal for general usage; in certain circumstances, its reduced intraoperative impact on hemodynamics makes it a worthwhile alternative.

Irrigation with Bupivacaine at the Surgical Bed for Postoperative Shoulder Tip and Abdominal Pain Relief after Laparoscopic Cholecystectomy

Gallstones in western countries are primarily composed of cholesterol. However, mixed or pigment stones, which contain a higher proportion of bilirubin, are more frequently seen in developing nations and Asia than in western countries. Abdominal and shoulder tip pains (STPs) are common complaints following the standard laparoscopic cholecystectomy procedure. To date, all pain management modalities have proven variable outcomes. This prospective randomized study included 82 patients who underwent elective laparoscopic cholecystectomy. The control group received 20 mL of normal saline, whereas the study group received a 20-mL instillation of 0.5% bupivacaine at the gallbladder bed after surgical resection. The Visual Analog Scale (VAS) was used to analyze abdominal pain and STP. The mean age ranged from 20 to 80 years. Abdominal VAS at 6, 12, 18, 24, 30, 36, and 48 hours were statistically insignificant. The majority were discharged on postoperative day 1 (32 studies, 37 control). Follow-up VAS after 1 week for STP VAS and abdominal pain VAS in both groups were statistically insignificant. Even with small numbers of a well-conducted randomized trial, we demonstrated that bupivacaine irrigation at the gallbladder bedpost laparoscopic cholecystectomy does not affect pain relief.

Comparative Study of Low Pressure versus Standard Pressure Carbon Dioxide Pneumoperitoneum in Reducing Shoulder Tip Pain Post Laparoscopic Cholecystectomy

Introduction: Laparoscopic cholecystectomy is the gold standard treatment for cholelithiasis. Postoperative shoulder tip pain is common complaint. Evidences suggest that using low pressure pneumoperitoneum (8-10 mmHg) during the procedure rather than standard pressure (12-14 mmHg) decreases the incidence and severity of shoulder tip pain without compromising working space.
 Aims: The aim of this study was to evaluate the impact of low pressure and standard pressure pneumoperitoneum on shoulder tip pain post laparoscopic cholecystectomy.
 Methods: A prospective hospital based study conducted at Nepalgunj Medical College, Kohalpur from January 2019 to December 2020. Hundred patients were enrolled, fifty each in “low pressure carbondioxide pneumoperitoneum” and “standard pressure carbondioxide pneumoperitoneum” groups, who underwent laparoscopic cholecystectomy. The two groups were compared in terms of incidence and severity of shoulder tip pain, surgeon’s satisfaction score, top-up analgesia requirement, procedural time, conversion to standard pressure, intraoperative complications and length of hospital stay.
 Results: There were 45 (90%) females and five (10%) males in low pressure group and 44 (88%) females and six (12%) males in standard pressure group. Fourteen (28%) patients in low pressure and 32 (64%) patients in standard pressure group had shoulder tip pain (p=0.001). The severity of shoulder tip pain was less in low pressure group and was significant at eight hours (p=0.006) and 12 hours (p=0.008). Top-up analgesia was required more in standard pressure group. There were no intraoperative complications but only one conversion to standard pressure. Surgeon’s satisfaction score, conversion to open cholecystectomy and procedural time were comparable in both groups with shorter hospital stay in low pressure group.
 Conclusion: Low pressure carbondioxide pneumoperitoneum is safe and effective strategy in reducing incidence and severity of shoulder tip pain after laparoscopic cholecystectomy.

EVALUATION OF POSTOPERATIVE SHOULDER TIP PAIN IN LOW PRESSURE VERSUS STANDARD PRESSURE PNEUMOPERITONEUM DURING LAPAROSCOPIC CHOLECYSTECTOMY

Introduction:- Insufation of carbon dioxide during laparoscopic cholecystectomy carries on to postoperative shoulder tip pain. The beginning of shoulder pain is commonly presumed to be due to overstretching of the diaphragmatic muscle bres due to high carbon dioxide pressure. Methods: - Patients came and admitted to the surgery department for elective cholecystectomy were enrolled in the study. The patients were randomly divided in two groups (group A and group B). In group A - low-pressure pneumoperitoneum (8 mm Hg) and in group B- standard pressure pneumoperitoneum (14 mm Hg) was created during laparoscopic cholecystectomy. Postoperative shoulder tip pain was evaluated at 4 hours and 24 hours after the operation. Results:- Fourteen patients or 28 % of patients in group B complained of postoperative shoulder tip pain as collated to only ve patients (10%) in group A. The mean intensity of postoperative shoulder tip pain assessed by the visual analogue scoring scale at 4 hours and 24 hours was less in group A as collated to group B. However, statistical signicance was seen only at four hours. Analgesic requirements and the mean length of postoperative stay in the hospital were minor in group-A as collated to group B. Conclusion: - Low-pressure laparoscopic cholecystectomy signicantly reduces the frequency and intensity of postoperative shoulder tip pain. Low-pressure laparoscopic cholecystectomy decreases the demand for postoperative analgesics, decreases postoperative hospital stay, and improves the quality of life in the initial stage of postoperative rehabilitation.

975 Outcome of Low Verus Standard Pressure Pneumoperitoneum in Laparoscopic Cholecystectomy: A Randomized Trial

Abstract Introduction Recent studies have shown that patients may experience considerable pain after laparoscopic cholecystectomy as well. Hence, this study was done to compare results on post op pain with low pressure pneumoperitoneum compared with standard pneumoperitoneum. Method 100 patients were selected for study and equally divided in two groups randomized into Low pressure (n = 50) and Standard pressure (n = 50). Operative time (min), postoperative pain (VAS) and frequency of Shoulder Tip Pain was noted in both groups Results A total of 100 patients were enrolled for this study. Patients were divided into two groups i.e. Group-A (Standard pressure) and Group-B (Low pressure). In group-A, there were 35(70%) males and 15(30%) females, while in group-B, there were 41(82%) males and 9(18%) females. Mean age of group-A patients was 42.0±7.0 years and 44.5±8.1 years in group-B. In group-A, 18(36%) patients had shoulder tip pain, while 4(8%) patients had had shoulder tip pain in group-B patients with a p-value of 0.001, which is statistically significant. Conclusions Laparoscopic cholecystectomy using low pressure pneumoperitoneum is feasible and results in less post-operative shoulder tip pain.

Correlation of shoulder tip pain in case of low pressure and standard pressure pneumoperitoneum post laparoscopic cholecystectomy

Background: Laparoscopic cholecystectomy is gold standard treatment for cholelithiasis now a days. Post-operative shoulder tip pain is common complain after laparoscopic cholecystectomy. The cause of this shoulder tip pain is multifactorial e.g. peritoneal stretching and diaphragmatic irritation. The main cause of this shoulder tip pain is pneumoperitoneum caused by carbon dioxide. Correlation of shoulder tip pain in case of low pressure (7-8 mmHg) and standard pressure (12-14 mmHg) pneumoperitoneum post laparoscopic cholecystectomy.Methods: A prospective randomized study was done in 100 patients of cholelithiasis in SMS hospital Jaipur Rajasthan. The patients were divided into two groups-Group A patients undergoing laparoscopic cholecystectomy at low pressure (7-8 mmHg) and group B patients undergoing laparoscopic cholecystectomy at standard pressure (12-14 mmHg). The intensity of shoulder tip pain were measured by visual analogue score at 1, 6, 12, 24 and 48 hours. In both of the group results were compared in terms of frequency of pain, intensity of pain and requirement of post-operative analgesics. The duration of hospital stay was also compared.Results: Post-operative shoulder tip was found to be less in low pressure group (group A) as compare to standard pressure group (group B). Total requirement of post-operative analgesic dose and hospital stay was also found to be less in low pressure group as compared to standard pressure group. This was statistically significant (p value<0.05).Conclusions: There is less intensity, frequency of shoulder tip pain, less post-operative analgesics requirement and less post-operative hospital stay after laparoscopic cholecystectomy done under low pressure pneumoperitoneum (7-8 mmHg).

A Randomized Trial of Low-Pressure (08–10 mm Hg) vs. Standard-Pressure (13–15 mm Hg) Pneumoperitoneum in Laparoscopic Cholecystectomy

The reported incidence of shoulder tip pain after laparoscopic cholecystectomy was 30%–50%. The aim of the present randomized controlled study was to compare the effects of low-pressure (08–10 mm Hg) vs. standard-pressure (13–15 mm Hg) pneumoperitoneum in patients undergoing laparoscopic cholecystectomy. One hundred patients between 18 and 70 years undergoing laparoscopic cholecystectomy were included. Group A and group B patients underwent low-pressure and standard-pressure pneumoperitoneum laparoscopic cholecystectomy respectively. Post-operative shoulder tip pain and post-operative abdominal pain were measured using visual analogue scale score at 2 h, 8 h, 24 h and 48 h after surgery. The primary outcome measures were the incidence and severity of post-operative shoulder tip pain, whereas secondary outcome measures were the incidence and severity of abdominal pain. Intergroup comparison of categorical and continuous variables was done using the chi-square test/Fisher’s exact test and unpaired ‘t’ test respectively. The incidence and severity of post-operative shoulder tip pain at 2 h, 8 h, 24 h and 48 h was significantly higher in group B as compared to group A. The incidence of post-operative abdominal pain at 48 h was significantly higher in group B as compared to group A. The severity of post-operative abdominal pain at 24 h and 48 h was significantly higher in group B as compared to group A. Low-pressure laparoscopic cholecystectomy significantly decreases the incidence and severity of post-operative shoulder tip and abdominal pain. Routine use of low-pressure pneumoperitoneum for the alleviation of post-operative pain following laparoscopic cholecystectomy is recommended.

Comparison of Trocar Site versus Trocar Site Plus Intraperitoneal Instillation of Local Anesthetic for Shoulder Pain Following Laparoscopic Abdominal Surgery.

Background:Laparoscopic surgery in recent times has noteworthy advantages over conventional surgery, yet recovery is prolonged due to debilitating shoulder tip pain (STP) and operated site pain. Various studies have compared the effect of trocar site, intraperitoneal instillation of local anesthetic (LA) for pain relief while only a few studies have tested the combination of these two techniques. Hence, this study was undertaken to compare the combination of these two techniques versus trocar site alone for STP particularly.Subjects and Methods:This prospective, randomized, comparative study was conducted on 52 patients who were undergoing laparoscopic abdominal surgery. The patients were allocated into either of the two groups. Group I (n = 26): trocar site infiltration (20 mL) and intraperitoneal instillation (20 mL) of 0.25% levobupivacaine and Group II (n = 26): trocar site infiltration (20 mL) of 0.25% levobupivacaine and saline (20 mL) intraperitoneally. Postoperative STP was the primary outcome while surgical site pain, nausea, and vomiting were secondary outcomes.Results:There were no statistically significant differences between the groups with regard to shoulder pain, surgical site pain, total rescue analgesics, and incidence of nausea and vomiting (P > 0.05).Conclusion:Trocar site infiltration with intraperitoneal instillation of LA or trocar site infiltration alone was found to be equally effective. However, we suggest that it is better to provide a combination of trocar site infiltration plus intraperitoneal instillation of LA if we have to restrict opioid usage such as in day-care surgeries.

Can spiral-shaped abdominal wall lift replace pneumoperitoneum in laparoscopic cholecystectomy? A randomised study

Background: A new design of abdominal lift system for gasless laparoscopy has been introduced in rural areas. Aims and Objectives: To assess whether the new spiral design abdominal wall lift system has similar outcomes to standard pneumoperitoneum laparoscopic cholecystectomy. Materials and Methods: Sixty cases of symptomatic gallstone disease scheduled for laparoscopic cholecystectomy were randomly assigned to gasless spiral abdominal wall lift or to standard pressure pneumoperitoneum, followed by cholecystectomy. Post-operative abdominal and shoulder tip pain, duration and ease of surgery and surgical site complications were compared. Results: There was a significant difference in post-operative abdominal pain at 24 hours after surgery (P Conclusion: Abdominal lift may be a valid alternative to pneumoperitoneum cholecystectomy with comparable outcomes in resource constrained areas.

Prospective randomized controlled trial on comparison of standard CO2 pressure pneumoperitoneum insufflator versus AirSeal\xae

BackgroundAirSeal® is a valve-free insufflation system that enables a stable pneumoperitoneum with continuous smoke evacuation and CO2 recirculation during laparoscopic surgery. Comparative evidence on the use of AirSeal® and standard CO2 insufflator in laparoscopic general surgery procedures is scarce. The aim of this study was to compare surgical outcomes between AirSeal® and standard CO2 insufflators in patients undergoing the most frequently performed laparoscopic procedures.MethodsOne hundred and ninety-eight patients undergoing elective laparoscopic cholecystectomy, colorectal surgery and hernia repair were randomized to either AirSeal® (group A) or standard pressure CO2 insufflator (group S). The primary endpoints were operative time and level of postoperative shoulder tip pain (Visual Analog Scale). Secondary outcomes included Clavien–Dindo grade complications, surgical side effect and length of hospital stay.ResultsPatients were randomized to either group A (n = 101) or group S (n = 97) and were analyzed by intention-to-treat. There was no significant difference in mean operative time between the groups (median [IQR]; 71 min [56–94] in group A vs. 69 min [52–93] in group S; p = 0.434). Shoulder tip pain levels were significantly lower in group S (VAS 0 [0–3] in group S vs. 2 [0–4] in group A; p = 0.001). There was no significant difference in complications, surgical side effects (subcutaneous emphysema was not observed in any group) and length of hospital stay.ConclusionThis randomized controlled trial showed that using the AirSeal® system did not reduce operative time and was associated with a higher postoperative shoulder tip pain compared to standard CO2 insufflator for short elective surgeries.ClinicalTrials.gov (NCT01740011).

Comparison of standard and low-pressure pneumoperitoneum; reduction in frequency and intensity of post-operative shoulder pain

Laparoscopic cholecystectomy is now gold standard and depends on good exposure of the peritoneal cavity. It is achieved by insufflation of the abdominal cavity with CO2. Operating at lower intraabdominal pressure (<12 -15mmHg) has been associated with fewer pulmonary and hemodynamic complications and lesser postoperative pain.
 Objective: To ascertain the advantages of low pressure pneumoperitoneum over standard pressure pneumoperitoneum
 Methods: Our study was quasi experimental study conducted at KRL Hospital, Islamabad over period of 3years from 2013 to 2016. SPSS version 20 was used to calculate p value. 
 Results: A total of 456 patients of gallstones were equally divided in two groups assigned to undergo low pressure (7-8mm of Hg) pneumoperitoneum or standard pressure (12-14mm of Hg) pneumoperitoneum laparoscopic cholecystectomy The average age of patients was 46.2+/-13.6yrs in group A compared to 43.5 +/- 12.9 in group B. There were 60 (26.3%) male and 168 (73.7%) female patients in group A compared to 53 (23.2% and 175 (76.85) in group B respectively. It was found that group A 14 (6.1%) had no pain, 26 (11.4%) had VAS between 1 – 7 and 188 (82.5%) had VAS of 8 – 10 where as in group B 164 (72.6%) patients reported no shoulder tip pain postoperatively, 42 (18.6%) had VAS of 1 – 7 and 20 (8.8%) had VAS OF 8 – 10. The difference was statistically significant (p-value = <0.001).
 Conclusions: reduced pressure of pneumoperitoneum to 7 – 8 mm of Hg produce lower incidence of postoperative shoulder tip pain.

Laparoscopic cholecystectomy in hepatitis C liver cirrhosis patients: “to drain or not to drain: impact on postoperative pain”

Background: When cirrhotic patients with symptomatic gallstones require laparoscopic cholecystectomy (LC), the drainage tube is supposed to prevent postoperative abdominal radiating to the right shoulder, nausea and vomiting due to pneumoperitoneum using carbon dioxide gas. Aim of this work is to evaluate the effect of placing of drains on the incidence of postoperative pain, nausea and vomiting in those patients.Methods: sixty-four patients with uncomplicated chronic calcular cholecystitis and liver cirrhosis were recruited for the study during the period from February 2017 to February 2019. They electively operated upon at the department of general surgery of Theodor Bilharz Research Institute (TBRI) using laparoscopic technique. Patients were subdivided into two equal groups Group-I (n=32); suction drains were placed in the sub-hepatic region (Morison’s pouch) and Group-II (n=32), no drains were placed. Duration of surgery, postoperative shoulder tip pain and vomiting and analgesics requirement were evaluated and recorded.Results: Operative time's difference was not statistically significant between the two groups. Drain group had a significant lower shoulder tip pain and analgesic requirement at post-operative 6 and 12 hours but that was higher After 12 hours, than group without drain. The overall incidence of nausea/vomiting was significantly higher statistically in group without drain than in drain group. Patients in drain group had a significantly longer hospital stay as compared to group without drain that was statistically significant.Conclusions: Although the incidence of pain and nausea/vomiting are less in early post-operative period after LC with abdominal drain in hepatitis C liver cirrhosis patients; its routine use is not justified because post-operative pain and analgesic requirement after 12 hours is higher and hospital stay is longer.

Intra-peritoneal bupivacaine in management of post operative shoulder tip pain following diagnostic laparoscopic procedure – a triple blind randomized control trial

Background: Post-operative shoulder-tip pain (STP) is a frequent complication following laparoscopy resulting in significant morbidity. This trial evaluates Intra-Peritoneal Bupivacaine (IPB) as a method of relieving post-operative STP. Methods: Fifty-eight patients undergoing diagnostic laparoscopies were randomized to Group A (treatment) and Group B (control). Group A (n = 28) received 0.25% bupivacaine and Group B (n =30) received an equal volume (10ml) of normal saline as an intra-peritoneal instillation in to the sub diaphragmatic space under direct vision. STP was recorded by using a visual analogue pain scale (VAS) at 0 hour, 4 hours, 8 hours of surgery, and at the time of discharge. Post-operative morbidity was assessed by additional analgesia and time taken for independent mobilisation. Results: The incidence rate of STP in control group (B) was 70% while only 25% (7 out of 28) had reported STP in treatment Group (A), which is statistically significant (P = 0.001). Both severity of STP (P=0.004) and post-operative additional analgesia (P=0.001) were significantly higher in control group (B). Group A had an early mobilization (Mean Hours 9.43). Among the adverse effects studied, only nausea was reported higher in Group A (P Conclusion: Per-operative intra-peritoneal instillation with bupivacaine significantly reduces both frequency and severity of STP following diagnostic laparoscopy while improving post-operative morbidity.

Comparative Analysis of Hemodynamic Changes and Shoulder Tip Pain Under Standard Pressure Versus Low-pressure Pneumoperitoneum in Laparoscopic Cholecystectomy.

ABSTRACTBackgroundLaparoscopic cholecystectomy is the gold standard procedure for cholelithiasis. Pneumoperitoneum is created using carbon dioxide (CO2) which is usually maintained at a range of 12-14 mm Hg. An emerging trend has been the use of low-pressure pneumoperitoneum in the range of 7-10 mm Hg in an attempt to lower the impact of pneumoperitoneum on the human physiology while providing adequate working space. Our study proposes to compare the effects of low-pressure pneumoperitoneum with the use of standard pressure of pneumoperitoneum.Aims and objectiveTo compare and analyze various factors like blood pressure, heart rate, end-tidal CO2 and postoperative shoulder tip pain in cases undergoing laparoscopic cholecystectomy using standard pressure versus low pressure.Materials and methodsThis is a prospective randomized study carried out at Santosh Medical College and Hospitals, Ghaziabad from September 2017 to December 2018. This study included 60 patients of cholelithiasis which were divided into two groups of 30 patients each. Group I was offered laparoscopic cholecystectomy under standard pressure pneumoperitoneum and group II underwent laparoscopic cholecystectomy using low-pressure pneumoperitoneum. Patients in each group were evaluated for various intraoperative physiological changes and postoperative shoulder tip pain.Observations and resultsCholelithiasis is commonly seen in middle-aged females. There is no significant difference in duration of surgery between the two groups. However, various factors like systolic blood pressure, heart rate, end-tidal CO2 were significantly better in the low-pressure group. Postoperative shoulder tip pain (measured by VAS scoring system) was significantly less in the low-pressure group during the first 24 hours.ConclusionLaparoscopic cholecystectomy under low-pressure pneumoperitoneum causes minimal physiological changes and less postoperative shoulder tip pain.How to cite this articleGoel A, Gupta S, et al. Comparative Analysis of Hemodynamic Changes and Shoulder Tip Pain Under Standard Pressure Versus Low-pressure Pneumoperitoneum in Laparoscopic Cholecystectomy. Euroasian J Hepatogastroenterol 2019;9(1): 5-8.

Spinal anaesthesia for laparoscopic cholecystectomy: A comparison with general anaesthesia regarding haemodynamic and respiratory stability

Spinal anaesthesia for laparoscopic cholecystectomy: A comparison with general anaesthesia regarding haemodynamic and respiratory stability - IJCA- Print ISSN No: - 2394-4781 Online ISSN No:- 2394-4994 Article DOI No:- 10.18231/j.ijca.2019.047, Indian Journal of Clinical Anaesthesia-Indian J Clin Anaesth

Low Pressure versus Standard Pressure Pneumoperitoneum in Laparoscopic Cholecystectomy

Background: the laparoscopic cholecystectomy (LC), one of the utmost commonly assumed operations in general surgery. Adequate working space inside the abdominal cavity is required. Carbon dioxide (CO2) is used with a definite pressure to establish this working space. Aim: our study was to compare the hemodynamic symptoms, post-operative shoulder-tip pain and the frequency of nausea and vomiting between standard and low-pressure CO2 pneumoperitoneum (PP) in patients undergoing LC. Patients and Methods: a prospective randomized study was done on 50 patients aged 18 to 75 years in Bab ElShaaria hospital, Al-Azhar University with symptomatic gallstones. Patients were allocated into two groups: standard pressure (Group A: 12-14 mmHg) and low-pressure (Group B: 8-10 mmHg). Hemodynamics were assessed pre insufflation and 15 min post insufflation and desufflation. The frequency of nausea and vomiting were assessed at 0, 8, 16, 24-hour post-operative. Post-operative shoulder- tip was assessed 1, 6, 12, 24-hour post-operative. Statistical analysis was postulated using SPSS V.25. Results: a noticeable difference between the two groups was observed with respect to the mean systolic blood pressure (p=0.003) and the mean heart rate (p=0.001). Furthermore, a significant difference as regard post-operative shouldertip pain, which was higher in the standard pressure group (p< 0.05). There were no major differences between the two groups concerning the frequency of nausea and vomiting. Conclusion: low-pressure PP can be used instead of standard pressure considering its low side effects without any effect on the working space and quality of the surgical procedure.

Dexmedetomidine Compared to Remifentanil Infusion as Adjuvant to Sevoflurane Anesthesia during Laparoscopic Sleeve Gastrectomy.

Objectives:Evaluation of postoperative (PO) analgesic effects of intraoperative (IO) Dexmedetomidine (DEX) compared to remifentanil (REMI) infusions during sevoflurane anesthesia for laparoscopic gastric sleeve surgery.Patients and Methods:One hundred and thirty-two patients with body mass index >35 kg.m-2 and ASA Grades II or III were randomly divided into group R received REMI infusion (6–18 μg.kg-1.h-1) and Group D received DEX infusion (0.2–0.5 μg.kg-1.h-1) after tracheal intubation till before stoppage of inhalational anesthetic. Heart rate and mean arterial pressure were noninvasively monitored during and after surgery. Emergence time, time until postanesthetic care unit transfer, and total operating room (OR) time was recorded. PO shoulder-tip pain and wound pain scores were recorded and rescue analgesia was provided as 50 mg pethidine intramuscular injection. Occurrence of PO nausea and vomiting (PONV) and frequency of the need for antiemetic therapy were recorded. Primary study outcome was the ability of the study infusions to reduce consumption of PO pethidine down to one dose during 24-hr PO.Results:IO use of REMI or DEX infusion allowed hemodynamic control to surgical stresses with nonsignificant difference between both infusions. REMI infusion insured significantly rapid recovery and short OR times but required larger volume of sevoflurane during surgery and proper PO follow-up for pain and PONV. DEX infusion significantly improved control of PO pain with a larger number of patient requested rescue analgesia only once, reduced the dose of PO analgesia, reduced the frequency of PONV, and the need for antiemetic therapy.Conclusion:REMI or DEX infusion as IO adjuvant to general anesthesia is appropriate option to achieve hemodynamic control of surgical stresses and to improve perioperative outcomes. REMI infusion may be preferred for its induced rapid recovery and short OR time, whereas DEX infusion may be chosen for its improved control of PO pain and reduction of PO analgesia and frequency of PONV.

Outcome analysis of low pressure versus high pressure pneumoperitoneum laparoscopic cholecystectomy: a randomized clinical study

Background: Laparoscopic cholecystectomy is established as gold standard for management of cholelithiasis. Intraoperative pneumoperitoneum affects the postoperative outcomes. The current stress is on increasing patient safety. Hence, this prospective study was undertaken to compare the effect of low pressure pneumoperitoneum (LPP &lt;10 mm Hg) versus high pressure pneumoperitoneum (HPP &gt; 14 mm Hg) on postoperative pain and ileus.Methods: 120 patients undergoing laparoscopic cholecystectomy were randomized into the LPP (&lt;10mm Hg) group (n=60) and the HPP (&gt;14 mm Hg) group (n=60). Total duration of surgery, intra-operative gas consumption, occurrence of bile spillage during operation, shoulder pain and abdominal pain in postoperative period, additional requirement of analgesia in postoperative period and postoperative ileus were assessed.Results: There was no significant difference in terms of operative duration, consumption of CO2 gas, intraoperative bile spillage, total hospital stay and tolerance to early feeding. The incidence of shoulder pain was higher in patients who underwent HPP laparoscopic cholecystectomy (p&lt;0.05). There was early recovery and early return of bowel activity in LPP which was statistically significant.Conclusions: Low-pressure pneumoperitoneum is feasible and safe and results in reduced postoperative shoulder tip pain and near-equal operative time with early return of bowel activity compared with high-pressure pneumoperitoneum.