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

Authors

  • Lakshman Agarwal Department of General Surgery, SMS Medical College, Jaipur, Rajasthan, India
  • Sanjay Kumawat Department of General Surgery, SMS Medical College, Jaipur, Rajasthan, India
  • Sumita A. Jain Department of General Surgery, SMS Medical College, Jaipur, Rajasthan, India
  • Amit Yadav Department of General Surgery, SMS Medical College, Jaipur, Rajasthan, India
  • Sandeep Sharma Department of General Surgery, SMS Medical College, Jaipur, Rajasthan, India

DOI:

https://doi.org/10.18203/2349-2902.isj20211820

Keywords:

Laparoscopic cholecystectomy, Low pressure, Post-operative shoulder pain, Standard pressure

Abstract

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).

References

Mc sherry CK. Cholecystectomy: the gold standard: Am J Surg. 1989;158:174-8.

Wallace DH, Serpell MG, Basxter JN, O’Dwyer PJ. (1997) Randomized trial of different insufflation pressures for laparoscopic cholecystectomy. Br J Surg. 1997;84:455-8.

Kanwer DB, Kaman L, Nedounsejiane M, Medhi B, Verma GR, Bala I. Comparative study of low pressure versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy: a randomised controlled trial. Trop Gastroenterol. 2009;30(3):171-4.

Edward ND, Barclay K, Catling SJ, Martin DG, Morgan RH. Day care laparoscopy: A survey of post-operative pain and assessment of the value of diclofenac. Anaesthesia. 1991;46:1077-80.

Barczynski M, Herman RM. A prospective randomized trial on comparison of low pressure and standard pressure pneumoperitoneum for laparoscopic cholecystectomy. Surg Endosc. 2003;17:533-8.

Perrakis E, Vezakis A, Velimezis G, Savanis G, Deverakis S, Antoniades J, et al. Randomized comparison between different insufflation pressures for laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech. 2003;13(4):245-9.

Dexter SP, Vucevic M, Gibson J, McMahon MJ. Preservation of hemodynamic function by low pressure laparoscopic cholecystectomy. Surg Endosc. 1995;9:600.

Sarli L, Costi R, Sansebastiano CG, Trivelli M, Roncoroni L. Prospective randomized trial of low-pressure pneumoperitoneum for reduction of shoulder tip pain following laparoscopy. Br J Surg. 2000;87:1161-5.

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

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

Downloads

Published

2021-04-28

Issue

Section

Original Research Articles