Prospective randomized trial of low-pressure pneumoperitoneum for reduction of shoulder-tip pain following laparoscopy

Background: Postoperative shoulder-tip pain occurs frequently following lap aroscopic cholecystectomy. The aim of this randomized clinical trial was to evaluate the efficacy of a low-pressure carbon dioxide pneumoperitoneum du ring laparoscopic surgery in reducing the incidence of postoperative should er-tip pain. Methods: Ninety consecutive patients undergoing laparoscopic cholecystectom y were randomized prospectively into low-pressure (group A) and normal-pres sure (group B) laparoscopic cholecystectomy groups. Patients in group A (n = 46) underwent laparoscopic cholecystectomy with 9 mmHg carbon dioxide pne umoperitoneum during most of the operation, and those in group B (n = 44) h ad laparoscopic cholecystectomy with 13 mmHg pneumoperitoneum. Shoulder-tip pain was recorded on a visual analogue pain scale 1, 3, 6, 12, 24 and 48 h after operation. Results: The low-pressure pneumoperitoneum did not increase the duration of surgery. There were no significant intraoperative or postoperative complic ations in either group. Fourteen patients (32 per cent) in group B and five (11 per cent) in group A complained of shoulder pain (P < 0.05). Mean shou lder-tip pain scores at 12 and 24 h and postoperative analgesia requirement s were also significantly lower in the low-pressure laparoscopic cholecyste ctomy group (P < 0.001). Conclusion: A carbon dioxide pneumoperitoneum pressure lower than that usua lly utilized to perform laparoscopic surgery reduces both the frequency and intensity of shoulder-tip pain following laparoscopic cholecystectomy.