To Evaluate Post-Operative Shoulder Tip Pain In Low Pressure (10mmhg Co2) Versus Standard Pressure (14mmhg Co2) Pneumoperitoneum In Laparoscopic Cholecystectomy, A One Year Randomised Controlled Trial, Hospital Based Study

Abstract

Background and objectives Improving post-operative pain has become an increasingly important issue. This study was aimed to compare postoperative shoulder tip pain and the use of analgesics postoperatively the use of the low pressure pneumoperitoneum with the use of standard pressure pneumoperitoneum in patients undergoing laparoscopic cholecystectomy. Methodology This one year Randomised Controlled Trial was conducted in the Department of General Surgery, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi from January 2015 to December 2015. A total of 80 patients undergoing elective laparoscopic cholecystectomy were enrolled. Based on ‘Sequential Numbered Opaque Envelope Method’ the patients were randomly divided into two groups of equal number as Group A (pneumoperitoneum with standard pressure of 14 mm Hg CO2) and Group B Patients underwent (pneumoperitoneum with low pressure of 10 mm Hg CO2). Results Most of the patients (67.50% each) in group A and Group B were females (p=1.000). The mean age of patients was almost equal in group A (46.93 ± 14.09 years) and (45.80 ± 13.07 years) in group B (p=0.712). The mean duration of surgery in group A and group B was comparable (71.43±18.43 vs 80.50±26.62 minutes; p=0.081). The mean pain scores at 1 (5.00±1.84 vs 2.20±1.22; p<0.001), 6 (4.10±1.57 vs 1.38±0.98; p<0.001), 12 (3.03±1.46 vs 0.68±0.83; p<0.001) and 24 (1.75±1.32 vs 0.35±0.48; p<0.001) hours were significantly low in group B compared to group A. The mean requirement of rescue analgesia was significantly high in group A compared to Group B at all the intervals (p<0.050). Conclusion and interpretation Low pressure pneumoperitoneum offers some benefit in terms of lower incidence and intensity of postoperative shoulder tip pain thereby results in lower consumption of rescue analgesia without altering the operative time.