Comparing postoperative pain in various pressure pneumoperitoneum of laparoscopic cholecystectomy: a double-blind randomized controlled study

Abstract

Purpose: This study aims to evaluate the effect of different pneumoperitoneum pressures on postoperative pain, especially by subcategorizing the pressures into 3 groups during laparoscopic cholecystectomy (LC).

Methods: We conducted a prospective randomized, double-blinded study of 150 patients with benign and uncomplicated gallbladder disease. They were categorized into 3 groups. Each group (50 patients) underwent LC with different pneumoperitoneum methods: group VLP, very-low pressure (6-8 mmHg); group LP, low pressure (9-11 mmHg); and group SP, standard pressure (12-14 mmHg). The 3 groups were compared for pain intensity, duration, analgesic requirement, and complications.

Results: The characteristics of the patients were similar among all groups. Postoperative pain scores at each time point (1, 2, 4, 6, 12, 24, and 48 hours) were not significantly different among the 3 groups. Further, operation time, hospital stay, the number of analgesic consumption doses, and postoperative complications were not significantly different among the 3 groups.

Conclusion: This study demonstrates no difference in postoperative pain among various pneumoperitoneum pressures during LC. Therefore, routine use of lower-pressure pneumoperitoneum is not recommended unless in selected patients who require low-pressure pneumoperitoneum surgery.

Keywords: Laparoscopic cholecystectomy; Pneumoperitoneum; Postoperative pain.

Fig. 1. CONSORT (Consolidated Standards of Reporting Trials) flow diagram. VLP, very-low pressure (6–8 mmHg pneumoperitoneum); LP, low pressure (9–11 mmHg pneumoperitoneum); SP, standard pressure (12–14 mmHg pneumoperitoneum).

Fig. 2. Postoperative pain score after laparoscopic cholecystectomy performed using very-low pressure (VLP, 6–8 mmHg), low pressure (LP, 9–11 mmHg), and standard pressure (SP, 12–14 mmHg) of pneumoperitoneum. The visual analog scale (VAS) score is presented as mean ± standard deviation at different time points. Comparing VAS results, there was no significant difference among the 3 groups (P > 0.05).