Faisal Bilal Lodhi, Riaz Hussain.
Laparoscopic Cholecystectomy; Low-pressure Pneumoperitoneum for shoulder-tip pain.
Professional Med J Jan ;10(4):266-70.

Background: Postoperative shoulder tip pain occurs frequently following laparoscopic cholecystectomy. The aim of this randomized clinical trial was to evaluate the efficacy of a low pressure carbon dioxide pneumoperitoneum during laparoscopic surgery in reducing the incidence of postoperative shoulder tip pain. Material & Methods: Ninety consecutive patients undergoing laparoscopic cholecystectomy were randomized prospectively into low pressure (group A) and normal pressure (group B) laparoscopic cholecystectomy groups. Patients in group A (n=46) underwent laparoscopic cholecystectomy with 10 mm Hg carbon dioxide pneumoperitoneum during most of the operation and those in group B (n=44) had laparoscopic cholecystectomy with 14 mmHg pneumoperitoneum. Shoulder tip pain was recorded on a visual analogue pain scale 1,3,6,12, 24 and 48 hours after operation. Results: The low pressure pneumoperitoneum did not increase the duration of surgery. There were no significant intraoperative or postoperative complications in either group. Fourteen patients (32%) in group B and five (11%) in group A complained of shoulder pain. Mean shoulder tip pain scores at 12 and 24 hours and postoperative analgesia requirements were also significantly lower in the low pressure laparoscopic cholecystectomy group. Conclusion: A carbon dioxide pneumoperitoneum pressure lower than that usually utilized to perform laparoscopic surgery reduces both the frequency and intensity of shoulder tip pain following laparoscopic cholecystectomy.

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