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Effect of low-pressure pneumoperitoneum on pain and inflammation in laparoscopic cholecystectomy: a randomized
Mohammad Rashdan1, Salam Daradkeh2, Mutasim Al-Ghazawi3
1Department of General Surgery/ Minimally invasive surgery, School of Medicine, Jordan University Hospital, The University of Jordan, Amman, Jordan. Rashdan4salt@yahoo.com.
Insights
Low-pressure pneumoperitoneum during laparoscopic cholecystectomy reduces postoperative pain and inflammatory markers. This technique is safe and effective, comparable to standard-pressure methods.
Area of Science:
- Minimally Invasive Surgery
- Surgical Inflammation
- Pain Management
Background:
- Standard pneumoperitoneum pressure for laparoscopic cholecystectomy is 12-14 mmHg.
- Lowering intra-abdominal pressure may reduce postoperative pain and improve hemodynamic stability.
- Limited research exists on the impact of low-pressure pneumoperitoneum on inflammatory markers.
Purpose of the Study:
- To evaluate the effect of low-pressure pneumoperitoneum (8-10 mmHg) versus standard-pressure (12-14 mmHg) on postoperative pain.
- To assess the impact of low-pressure pneumoperitoneum on ten key inflammatory markers.
- To compare operative outcomes and feasibility between low- and standard-pressure pneumoperitoneum.
Main Methods:
- Prospective, double-blinded, randomized controlled trial.
- 100 patients undergoing elective laparoscopic cholecystectomy were randomized (1:1) to low- or standard-pressure groups.
- Perioperative variables, including pain scores and inflammatory markers, were collected and analyzed.
Main Results:
- Patients in the low-pressure group reported significantly lower median pain scores at 6 hours postoperatively (5 vs. 6, p=0.021).
- Eight of ten inflammatory markers showed a trend towards lower levels in the low-pressure group, though not statistically significant.
- Operative time and surgical difficulty were comparable between groups, irrespective of surgeon experience.
Conclusions:
- Low-pressure pneumoperitoneum in laparoscopic cholecystectomy is associated with reduced postoperative pain and a lower inflammatory response.
- The technique is feasible and demonstrates comparable complication rates to standard-pressure pneumoperitoneum.
- This approach offers a potentially improved patient recovery profile.
Objective:
We aim to assess the effect of low-pressure pneumoperitoneum on post operative pain and ten of the known inflammatory markers.
Background:
The standard of care pneumoperitoneum set pressure in laparoscopic cholecystectomy is set to 12-14 mmHg, but many societies advocate to operate at the lowest pressure allowing adequate exposure of the operative field. Many trials have described the benefits of operating at a low-pressure pneumoperitoneum in terms of lower post operative pain, and better hemodynamic stability. But only few describe the effects on inflammatory markers and cytokines.
Methods:
A prospective, double-blinded, randomised, controlled clinical trial, including patients who underwent elective laparoscopic cholecystectomy. Patients randomised into low-pressure (8-10 mmHg) vs. standard-pressure (12-14 mmHg) with an allocation ratio of 1:1. Perioperative variables were collected and analysed.
Results:
one hundred patients were allocated, 50 patients in each study arm. Low-pressure patients reported lower median pain score 6-hour post operatively (5 vs. 6, p-value = 0.021) in comparison with standard-pressure group. Eight out of 10 inflammatory markers demonstrated better results in low-pressure group in comparison with standard-pressure, but the effect was not statistically significant. Total operative time and surgery difficulty was not significantly different between the two groups even in the hands of inexperienced surgeons.
Conclusion:
low-pressure laparoscopic cholecystectomy is associated with less post operative pain and lower rise of inflammatory markers. It is feasible with comparable complications to the standard of care. Registered on ClinicalTrials.gov (NCT05530564/ September 7th, 2022).
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