RESIDUAL PNEUMOPERITONEUM - A CAUSE OF POSTOPERATIVE PAIN AFTER LAPAROSCOPIC CHOLECYSTECTOMY

After laparoscopic cholecystectomy, residual gas is inevitably retaine d in the peritoneal cavity. An active attempt is not always made to re move it. Using a double-blind prospective protocol in 40 healthy patie nts, we evaluated the effect of residual pneumoperitoneum on post-lapa roscopic cholecystectomy pain intensity. On completion of surgery, pri or to removal of the surgical instruments, the patients were randomly divided into two groups: in the active aspiration (AA) group an active attempt was made to remove as much gas as possible from the peritonea l cavity, while in the nonactive aspiration (NAA) group no such effort was made. Postoperative pain was assessed hourly over a 4-h period wi th a visual analog scale (VAS) and a patient-controlled analgesia (PCA ) device. During the first postoperative hour, the NAA patients made s ignificantly (P < 0.05) more demands (mean +/- SD) for morphine than t hose in the AA group (31.3 +/- 26.2 vs 15.3 +/- 15.7) and also receive d a borderline significantly (P = 0.056) larger dose (mean +/- SD) of PCA morphine (3.9 +/- 1.9 mg vs 2.7 +/- 1.3 mg). The VAS scores (mean +/- SD) over the 4-h study period were similar in bath groups, being h igh during the first postoperative hour (AA = 5.1 +/- 2.1 vs NAA = 6.1 +/- 2.2) and then decreasing. We conclude that residual pneumoperiton eum is a contributing factor in the etiology of postoperative pain aft er laparoscopic cholecystectomy.