LAPAROSCOPIC CHOLECYSTECTOMY

LOW-PRESSURE PNEUMOPERITONEUM FOR SHOULDER-TIP PAIN

Abstract

Background: Postoperative shoulder tip pain occurs frequently following laparoscopic cholecystectomy. The aim of this
randomized clinical trial was to evaluate the efficacy of a low pressure carbon dioxide pneumoperitoneum during laparoscopic
surgery in reducing the incidence of postoperative shoulder tip pain. Material & Methods: Ninety consecutive patients undergoing
laparoscopic cholecystectomy were randomized prospectively into low pressure (group A) and normal pressure (group B)
laparoscopic cholecystectomy groups. Patients in group A (n=46) underwent laparoscopic cholecystectomy with 10 mm Hg carbon
dioxide pneumoperitoneum during most of the operation and those in group B (n=44) had laparoscopic cholecystectomy with 14
mmHg pneumoperitoneum. Shoulder tip pain was recorded on a visual analogue pain scale 1,3,6,12, 24 and 48 hours after
operation. Results: The low pressure pneumoperitoneum did not increase the duration of surgery. There were no significant
intraoperative or postoperative complications in either group. Fourteen patients (32%) in group B and five (11%) in group A
complained of shoulder pain. Mean shoulder tip pain scores at 12 and 24 hours and postoperative analgesia requirements were
also significantly lower in the low pressure laparoscopic cholecystectomy group. Conclusion: A carbon dioxide
pneumoperitoneum pressure lower than that usually utilized to perform laparoscopic surgery reduces both the frequency and
intensity of shoulder tip pain following laparoscopic cholecystectomy.