The effect of active gas suctioning to decrease the residual CO2 for preventing post-laparoscopic cholecystectomy shoulder pain

Abstract EN

Shoulder pain, apparently specific to laparoscopic surgery is one of the early post-laparoscopic symptoms related to residual CO2 used for pneumoperitoneum and remaining in the abdomen after the operation.

This study was conducted to observe the effect of active gas suctioning to decrease the residual CO2 for preventing postlaparoscopic shoulder pain.

Methods : One hundred and thirty six patients (ASA class I and II) scheduled for elective laparoscopic cholecystectomy, were randomly assigned into two groups A and B.

Group A, are cases with the ordinary procedure (passive deflation of the abdomen), while group B included active suctioning following laparoscopic surgery.

A proforma sheet was used in collecting data from each patient including the following information : Age, weight, intraperitoneal pressure, the duration of the operation and pain assessment score sheet.

Results : Seventy five (55.15 %) patients were ASA class I and 61 (44.85 %) patients were ASA class II.

The overall male / female ratio is 23 / 113 (16.91 % / 83.09 %).

Postoperative shoulder pain at 4, 8, 12 and 16 hours was significantly decreased in the group B compared with group A (p = 0.001).

The number of patients who received analgesics postoperatively was compared in groups A and B.

Analgesics were used in 30 (22.1 %) patients in group A and 15 (11 %) patients in group B, (p < 0.019) which is statistically significant.

Hospital stay was shorter in group B (20 hours) than in group a (26.4 hours).

Conclusions : Active peritoneal suctioning at the end of laparoscopic surgery effectively evacuates residual CO2 thus preventing postlaparoscopic shoulder pain.

Residual CO2 after laproscopic surgery should be removed as completely as possible in all the cases.

It is most likely a combination of direct stretching of the diaphragm caused by insufflation and the release of hydrogen ions as a consequence of the reaction between CO2 and water: CO2 + H2O ↔ H2CO3 ↔ H+ + HCO3–.

The free H + radical acid may irritate the phrenic nerve.

It is desirable to prevent or diminish this symptom.

A number of studies have looked at methods to reduce the incidence and severity of shoulder pain following laparoscopic surgery for example : Low pressure insufflation, 18, 19 low rate of insufflation, 20 gasless laparoscopy, 21 warmed gas, 22 preemptive anti-inflammatory medication, 23 preemptive subdiaph-ragmatic local anesthetic irrigation, 24 regional anesthesia to peritoneal surface in operative area25-28and pulmonary recruitment maneuver.

29, 30 The aim of the study was to evaluate the effect of active peritoneal suctioning after CO2 pneumoperitonium on postlaparoscopic cholecystectomy shoulder pain.