DOI: https://doi.org/10.22141/2224-0586.6.93.2018.147644

Postoperative abdominal pain in patients after laparoscopic surgery in gynecology

O.O. Volkov, O.M. Klygunenko, V.V. Lutsenko, P.O. Braila

Abstract


Background. Pneumoperitoneum with carbon dio­xide insufflation is thought to be the most important cause of postoperative pain. Reduction of pneumoperitoneum pressure may reduce surgical visualization. Today, intraabdominal pressure is traditionally set at a routine pressure of 12–15 mmHg. Keeping in mind the potential negative impact of pneumoperitoneum on cardiopulmonary function and the positive impact on postoperative pain, international guidelines recommend that “the lowest intraabdominal pressure allowing adequate exposure of the operative field rather than a routine pressure” should be used. The use of deep neuromuscular blockade improves surgical conditions during a low-pressure pneumoperitoneum. But some surgeons still prefer high-pressure one. In literature, low-pressure pneumoperitoneum is generally defined as an intraabdominal pressure of 6–10 mmHg. Howe­ver, in daily clinical practice, the intra-abdominal pressure is usual­ly set at 12–14 mmHg, and for gynecological laparoscopic procedures, sometimes even higher pressures are used. The purpose of our study was to determine the effect of pneumoperitoneum pressure on anesthetic and opioid consumption, recovery after laparoscopic intervention and early postoperative pain. Materials and methods. Having agreed with the local ethics committee and obtained the informed consents, 34 women (scheduled for laparoscopic cystectomy) were exa­mined. They were randomized into 2 groups: N (n = 18) — normal-pressure pneumoperitoneum (12 mmHg) and H (n = 16) — high-pressure one (15 mmHg). Pain was assessed on a visual analogue scale in 1, 5 and 24 h after surgery. Other endpoints were opioid consumption; anaesthetic consumption; time to mobilization; time to extubation; duration of surgery. Both groups were similar in terms of age, height, weight, physical status (ASA I–II). Data are presented as mean ± SD or percentage of patients with parameters. Mann-Whitney U test was used for statistical analysis, p < 0.05 was considered as statistically significant for comparison between groups. Results. Postoperative pain was significantly lower in group N, both in 5 and 24 hours, and did not differ after 1 hour. The consumption of fentanyl, sevoflurane and atracurium did not differ between groups (p = 0.06, p = 0.61 and p = 0.95). Wo­men started walking the same time after the operation. Pain in the shoulders was detected in fe­wer women after 24 hours in the N group, although it was not significant. Correlation was revealed between pneumoperitoneum pressure and the visual analogue scale score after 5 hours (0.73, p = 0.034) and 24 hours (0.65, p = 0.044). Conclusions. Normal-pressure pneumoperitoneum (12  mmHg) reduced the level of early post­operative pain after laparoscopic cystectomy in comparison with high-pressure (15 mmHg) one. Further studies are nee­ded to establish the effect of pneumoperitoneum pressure on the consumption of anesthetics.


Keywords


laparoscopy, pneumoperitoneum, postoperative pain, anesthesia.

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