Abdominal pain and shoulder tip pain after laparoscopic cholecystectomy are distressing for the patient. Various causes of this pain are peritoneal stretching and diaphragmatic irritation by high intra-abdominal pressure caused by pneumoperitoneum. We designed a study to compare the postoperative pain after laparoscopic cholecystectomy at low pressure (7-8 mm Hg) and standard pressure technique (12-14 mm Hg).

To compare the effect of low pressure and standard pressure pneumoperitoneum in post-laparoscopic cholecystectomy pain. Further to study, the safety of low pressure pneumoperitoneum in laparoscopic cholecystectomy.

A prospective randomized double blind study.

A prospective randomized double blind study was done in 50 ASA grade I and II patients. They were divided into two groups—25 each. Group A, patients underwent laparoscopic cholecystectomy with low pressure pneumoperitoneum (7-8 mm Hg) while group B, underwent laparoscopic cholecystectomy with standard pressure pneumoperitoneum (12-14 mm Hg). Both the groups were compared for pain intensity, analgesic requirement and complications. Shoulder tip pain was recorded on a visual analog pain scale 1, 6, 12, 24 and 48 hours after operation.

Demographic data and intraoperative complications were analyzed using Chi-square test. Frequency of pain, intensity of pain, analgesics consumption and other pneumoperitoneum related complications were compared by applying ANOVA test.

Postoperative pain score was significantly less in low pressure group as compared to standard pressure group. Number of patients requiring rescue analgesic doses was more in standard pressure group. This was statistically significant. Also total analgesic consumption was more in standard pressure group. There was no difference in intraoperative complications.

This study demonstrates the use of simple expedient of reducing the pressure of pneumoperitoneum to 8 mm results in reduction in both intensity and frequency of postoperative pain, and hence early recovery and better outcome. This study also shows that low pressure technique is safe with comparable rate of intraoperative complications.

Zaman M, Chowdhary K, Goyal P. Prospective Randomized Trial of Low Pressure Pneumoperitoneum for Reduction of Shoulder Tip Pain following Laparoscopic Cholecystectomy: A Comparative Study. World J Lap Surg 2015;8(1):13-15.