Intraperitoneal gas drain to reduce pain after laparoscopy: Randomized masked trial

OBJECTIVE: To determine whether a drain placed in the peritoneal cavity dur ing laparoscopy is both a clinical and cost-effective method of reducing po stoperative pain. METHODS: Two hundred twenty-five women undergoing diagnostic or minor opera tive laparoscopic procedures were recruited. Women were assigned to receive either an intraperitoneal gas drain or a dummy drain during surgery. Sampl e size to detect a two-point difference in visual analogue score was estima ted at 158 subjects, with 79 in each arm. The patients and nursing staff we re unaware of the position of the drain. A visual analogue scare was used t o assess pain preoperatively and at 4, 24, and 48 hours postoperatively. Da ta on the experience of nausea, frequency of vomiting, and site of pain wer e collected. The analgesic and antiemetic use was recorded. An economic eva luation of the analgesic use and the material costs for the two groups was performed. RESULTS: One hundred sixty-one complete sets of data (72%) were available f or analysis. The two groups were well matched for age, parity, previous sur gery, body mass index, volume of carbon dioxide used, and operative time. N o significant differences were found between the two groups with regard to the overall pain scores preoperatively (8 versus 7) or at 4 (30 versus 34), 24 (40 versus 44), and 48 (26 versus 26) hours postoperatively, after adju sting for multiple point testing. On assessment at different sites, the dum my drain group experienced shoulder pain more frequently at 4 (19 of 79 ver sus 10 of 82, P = .05) and 48 (16 of 79 versus 7 of 82, P = .03) hours post operatively compared with the drain group. The placebo group had a 33% grea ter usage of oral analgesia after discharge, but this was $2.50 cheaper tha n the use of an intraperitoneal drain. No statistically significant differe nces were found between the groups with regard to nausea and vomiting posto peratively. CONCLUSION: An intraperitoneal drain after minor gynecologic laparoscopy de creases the frequency of shoulder pain and reduces postoperative analgesia requirements. However, it is less cost-effective to reduce pain using an in traperitoneal gas drain than simple oral analgesia after minor gynecologic laparoscopy. (C) 2001 by the American College of Obstetricians and Gynecolo gists.