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Postoperative pain after low-pressure versus standard-pressure laparoscopic surgery in children. A randomized
Hannah R Neeser1, Tim Gerwinn2, Victoria C Forschbach2
1Department of Pediatric Surgery, University Children's Hospital Zurich, University of Zurich, Lenggstrasse 30, 8008 Zürich, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, August-Forel-Strasse 51, 8008 Zürich, Switzerland.
Insights
Low-pressure pneumoperitoneum (LPP) did not reduce postoperative pain in children undergoing laparoscopic appendectomy compared to standard-pressure pneumoperitoneum (SPP). In fact, LPP was associated with increased abdominal and shoulder pain in pediatric patients.
Area of Science:
- Pediatric Surgery
- Pain Management
- Minimally Invasive Procedures
Background:
- Postoperative pain remains a significant issue for children after laparoscopic surgery.
- Low-pressure pneumoperitoneum (LPP) is hypothesized to reduce pain, but evidence in pediatric populations is lacking.
- This study investigated LPP's efficacy in school-aged children undergoing appendectomy.
Purpose of the Study:
- To determine if low-pressure pneumoperitoneum (LPP) reduces postoperative abdominal pain compared to standard-pressure pneumoperitoneum (SPP).
- To evaluate the impact of LPP on pain intensity and other outcomes in children undergoing laparoscopic appendectomy.
Main Methods:
- A single-center, parallel-group, superiority randomized controlled trial was conducted.
- Children aged 5-17 years undergoing laparoscopic appendectomy were randomized to LPP (8 mmHg) or SPP (12 mmHg).
- The primary outcome was postoperative abdominal pain assessed using the revised Faces Pain Score on postoperative day 1.
Main Results:
- Contrary to the hypothesis, LPP was associated with higher postoperative abdominal pain scores (OR 1.74) compared to SPP.
- Shoulder pain scores were also higher in the LPP group (OR 2.11), with a significant right-sided predominance.
- Surgeons rated the intraoperative view as superior during SPP; no other significant differences were observed.
Conclusions:
- Low-pressure pneumoperitoneum (LPP) does not reduce postoperative pain in children undergoing laparoscopic appendectomy.
- Standard-pressure pneumoperitoneum (SPP) may offer a better intraoperative view without increasing postoperative pain.
- Further research may explore alternative strategies for pediatric pain management after laparoscopic surgery.
Background:
Children still suffer from substantial pain after laparoscopic surgery. It has been hypothesized that low-pressure pneumoperitoneum reduces postoperative pain after laparoscopic surgery. However, this has not yet been studied in school-aged children. Our objective was to determine whether low-pressure pneumoperitoneum (LPP) reduces postoperative abdominal pain compared to standard-pressure pneumoperitoneum (SPP) in children undergoing laparoscopic appendectomy for acute appendicitis.
Methods:
Single-center, parallel-group, superiority randomized controlled trial including children aged 5-17 years undergoing laparoscopic appendectomy. Patients with four-quadrant peritonitis, intraabdominal abscess on ultrasound, or insufficient local language skills to assess postoperative pain were excluded. Patients were randomized to laparoscopic appendectomy with LPP (8 mmHg; intervention arm) or SPP (12 mmHg; control arm). The primary outcome was postoperative abdominal pain intensity, measured using the revised Faces Pain Score on the first postoperative day. Secondary outcomes were shoulder pain intensity, operative time, length of stay, surgeon-rated intraoperative view, analgesic use, intra- and postoperative complications.
Results:
Of 250 randomized patients, 191 completed the study per protocol (LPP n = 81, SPP n = 110). Median age was 11.55 years and median weight 40 kg. Contrary to our hypothesis, LPP was associated with higher postoperative abdominal (odds ratio [OR] 1.74, 95% CI 1.01-3.00) and shoulder pain scores (OR 2.11, 95% CI 0.84-5.31) compared to SPP. Shoulder pain was more intense on the right side in both groups (OR 7.81, 95% CI 3.92-15.55). Intraoperative view was rated as superior by surgeons during SPP. There were no significant differences between groups regarding all other secondary outcomes.
Conclusions:
In children undergoing laparoscopic appendectomy, LPP does not reduce postoperative pain compared to SPP.
