Authors: Hemanga K Bhattacharjee Azarudeen Jalaludeen Virinder Bansal Asuri Krishna Subodh Kumar Rajeshwari Subramanium Rashmi Ramachandran Mahesh Misra
Publish Date: 2016/07/21
Volume: 31, Issue: 3, Pages: 1287-1295
Abstract
The incidence of shoulder pain SP following laparoscopic cholecystectomy LC varies between 21 and 80 A few randomised controlled trials and metaanalysis have shown lesser SP in LC performed under lowpressure carbon dioxide pneumoperitoneum LPCP than under standardpressure carbon dioxide pneumoperitoneum SPCP However the possible compromise in adequate exposure and effective working space during LPCP has negatively influenced its uniform adoption for LCAll consecutive patients undergoing elective LC for gallstone disease who met the inclusion and exclusion criteria were enroled Fourty patients were randomised to SPCP group pressure of 14 mmHg and 40 to LPCP group pressure of 9–10 mmHg Primary outcome measured was incidence of SP and its severity on visual analogue scale VAS at 4 8 24 h and 7 days after LC Secondary outcomes measured were procedural time technical difficulty surgeons’ satisfaction score on exposure and working space intraoperative changes in heart rate and blood pressure abdominal pain and analgesic requirement Analyses were performed using Stata softwareThere was no conversion to open surgery bile duct injury or need to increase intraabdominal pressure on either group Twentythree patients 575 in SPCP group and nine patients 225 in LPCP group had SP p = 0001 The severity of SP was significantly more in SPCP group at 8 and 24 h p = 0009 and 0005 respectively Both the groups had similar procedural time surgeons’ satisfaction score intraoperative changes in heart rate and blood pressureThe incidence and severity of SP following LC performed at LPCP are significantly less compared to that in SPCP The safety efficacy and surgeons’ satisfaction appear to be comparable in both the groups Hence a routine practice of lowpressure carbon dioxide pneumoperitoneum may be recommended in selected group of patients undergoing laparoscopic cholecystectomy
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