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

  • Sania Waseem Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
  • Humera Naz Altaf Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
  • Sehrish Latif Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
  • Omar Shahzad Altaf Al Nafees Medical College, Islamabad, Pakistan
  • Fareeha Farooqui Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
  • Sohaib Khan Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
Keywords: Laparoscopy, pain syndrome, cholecystectomy, pneumoperitoneum

Abstract

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.

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Author Biographies

Sania Waseem, Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan

Senior Registrar

Humera Naz Altaf, Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan

Assistant Professor, Department of Surgery

Sehrish Latif, Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan

Senior Registrar

Omar Shahzad Altaf, Al Nafees Medical College, Islamabad, Pakistan

Assistant Professor, Department of Surgery

Fareeha Farooqui, Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan

Associate Professor, Department of Surgery

Sohaib Khan, Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan

Assistant Professor, Department of Surgery

References

Eryılmaz HB, Memiş D, Sezer A, Inal MT. The effects of different insufflation pressures on liver functions assessed with LiMON on patients undergoing laparoscopic cholecystectomy. The Sci World J. 2012; 2012.

DOI: https://doi.org/10.1100/2012/172575

Singla S, Mittal G, Raghav, Mittal RK. Pain Management after Laparoscopic Cholecystectomy-A Randomized Prospective Trial of Low Pressure and Standard Pressure Pneumoperitoneum. J Cli Diagn Res 2014; 8(2):92-94.

DOI: https://doi.org/10.7860/JCDR/2014/7782.4017

Joshipura VP, Haribhakti SP, Patel NR, Naik RP, Soni HN, Patel B, et al. A prospective randomized, controlled study comparing low pressure versus high pressure pneumoperitoneum during laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech. 2009; 19:234–40.

DOI: https://doi.org/10.1097/SLE.0b013e3181a97012

Kandil TS, El Hefnawy E. Shoulder pain following laparoscopic cholecystectomy: factors affecting the incidence and severity. J Laparoendosc Adv Surg Tech A. 2010; 20:677–82.

DOI: https://doi.org/10.1089/lap.2010.0112

Yasir M, Mehta KS, Banday VH, Aiman A, Masood I, Iqbal B. Evaluation of post-operative shoulder tip pain in low pressure versus standard pressure pneumoperitoneum during laparoscopic cholecystectomy. Surgeon. 2012; 10(2):71–4.

DOI: https://doi.org/10.1016/j.surge.2011.02.003

Kar M, Kar JK, Debnath B. Experience of laparoscopic cholecystectomy under spinal anesthesia with low-pressure pneumoperitoneum-prospective study of 300 cases. Saudi J Gastro: 2011; 17(3):203.

DOI: https://doi.org/10.4103/1319-3767.80385

Sandhu T, Yamada S, Ariyakachon V, Chakrabandhu T, Chongruksut W, Ko-iam W. Low pressure pneumopertoneum versus standard pneumoperitoneum in laparoscopic cholecystectomy, a prospective randomized clinical trial. Surg Endosc. 2009; 23(5):1044–7.

DOI: https://doi.org/10.1007/s00464-008-0119-2

Gurusamy KS, Samraj K, Davidson BR. Low pressure versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy. Cochrane Database Syst Rev. 2009.

DOI: https://doi.org/10.1002/14651858.CD006930.pub3

Strang CM, Freden F, Maripuu E, Ebmeyer U, Hachenberg T, Hedenstierna G. Improved ventilation-perfusion matching with increasing abdominal pressure during CO(2) -pneumoperitoneum in pigs. Acta Anaesthesiol Scand. 2011; 55(7):887–96.

DOI: https://doi.org/10.1111/j.1399-6576.2011.02464.x

Phelps P, Cakmakkaya OS, Apfel CC, Radke OC. A simple clinical maneuver to reduce laparoscopy induced shoulder pain. A randomized controlled trial. Obstet Gynecol. 2008; 111(5):1155–60.

DOI: https:doi.org/10.1097/AOG.0b013e31816e34b4.

Ra YS, Kim CH, Lee YG, Han JI. The analgesic effect of the ultrasound guided transverse abdominis plane block after laparoscopy cholecystectomy. Korean J Anesthesiol. 2010; 58(4):362–68.

DOI: https://doi.org/10.4097/kjae.2010.58.4.362

Behnaz F, Nooraei N, Moghaddas D, Mohajerani SA. Effects of intraabdominal pressure onpost-operative discharge criteria in laparoscopic cholecystectomy. Arch Cri Care 2016; 2(4):255-7.

Azevedo JL, Azevedo OC, Miyahira SA, et al. Injuries caused by Veress needle insertion for creation of pneumoperitoneum: a systematic literature review. Surg Endosc. 2009; 23(7):1428-32.

DOI: https://doi.org/10.1007/s00464-009-0383-9

Kim TH, Kang HK, Park JS, Chang IT, Park SG. Intraperitoneal ropivacaine instillation for postoperative pain relief after laparoscopic cholecystectomy. J Korean Surg Soc. 2010; 79(2):130-6.

DOI: https://doi.org/10.4174/jkss.2010.79.2.130

Hatipoglu S, Akbulut S, Hatipoglu F, Abdullayev R. Effect of laparoscopic abdominal surgery on splanchnic circulation: historical developments. World J Gastroenterol. 2014; 20(48):18165-18176.

DOI: https://doi.org/10.3748/wjg.v20.i48.18165

Goyal S, Singla S. Laparoscopic cholecystectomy under spinal anesthesia with low pressure pneumoperitoneum-prospective study of 150 cases. Arch Clin Experimental Surg 2012; 1:224-28.

DOI: https://doi.org/10.5455/aces.20120309094124

Nabi S, Nazima S, Bashir Y, Beigh A, Bashir N, Angmo D. Low pressure pneumoperitoneum versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy an experience. Int J Adv Res. 2017; 5(8):1771-8.

Özdemir-van Brunschot DMD, van Laarhoven KCJHM, Scheffer G-J, Pouwels S, Wever KE, Warlé MC. What is the evidence for the use of low-pressure pneumoperitoneum? A systematic review. Surgical Endoscopy. 2016; 30:2049-2065.

DOI: https://doi.org/10.1007/s00464-015-4454-9.

Nandhagopal V, Chandra SS, Pankaj K,Ananthanarayan, Hariharan AP, Karthikeyan, Vilvapathy Senguttuvan KV, Manwar AS, et al. Comparison of Standard-pressure and Low-pressure Pneumoperitoneum in Laparoscopic Cholecystectomy: A Double Blinded Randomized Controlled Study. Surg Laparosc Endosc Percutan Tech. 2014; 24(2):127-133.

DOI: https://doi.org/10.1097/SLE.0b013e3182937980.

Warle MC, et al. Low-pressure pneumoperitoneum during laparoscopic donor nephrectomy to optimize live donors’ comfort. Clin Transplant. 2013; 27(4):E478-483.

DOI: https://doi.org/10.1111/ctr.12143.

Donatsky AM, Bjerrum F, Gogenur I. Surgical techniques to minimize shoulder pain after laparoscopic cholecystectomy. A systematic review. Surg Endosc. 2013; 27(7):2275-2282.

DOI: https://doi.org/10.1007/s00464-012-2759-5.

Bogani G, Uccella S, Cromi A, Serati M, Casarin J, Pinelli C, Ghezzi F. Low vs Standard Pneumoperitoneum Pressure During Laparoscopic Hysterectomy: Prospective Randomized Trial. The Journal of Minimally Invasive Gynecology. 2014; 21 (3):466-71.

DOI: https://doi.org/10.1016/j.jmig.2013.12.091

Singh R, Suryawanshi PR, Singh K. A Prospective Randomized Clinical Study of Comparing Low Pneumoperito-neum Pressure Versus Standard Pressure for Reduction of Shoulder Tip Pain in Laparoscopic Cholecystectomy. J Surg. 2017;192.

DOI: https://doi.org/ 10.29011/2575-9760.000192

Donatsky AM1, Bjerrum F, Gögenur I. Surgical techniques to minimize shoulder pain after laparoscopic cholecystectomy. A systematic review. Surg Endosc. 2013; 27(7):2275-82.

DOI: https://doi.org/10.1007/s00464-012-2759-5.

Hua J, Gong J, Yao L, Zhou B, Song Z. Low-pressure versus standard-pressure pneumoperitoneum for laparoscopic cholecystectomy: a systematic review and meta-analysis. Am J Surg. 2014; 208(1):143-50.

DOI: https://doi.org/10.1016/j.amjsurg.2013.09.027

Published
2019-12-19
How to Cite
1.
Waseem S, Altaf H, Latif S, Altaf O, Farooqui F, Khan S. Comparison of standard and low-pressure pneumoperitoneum; reduction in frequency and intensity of post-operative shoulder pain. JSTMU [Internet]. 19Dec.2019 [cited 1Dec.2020];2(2):47-1. Available from: https://j.stmu.edu.pk/ojs/index.php/jstmu/article/view/47