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Low pressure (8 mmHg) pneumoperitoneum does not significantly reduce postoperative visual analog scale score after
Amine Ben Safta1,2, Salsabil Nasri1,2, Imen Samaali1,2
1Department of Digestive Surgery B, Charles Nicolle University Hospital, Tunis, Tunisia.
Background:
Low-pressure pneumoperitoneum (LPP) has been proposed to improve postoperative pain in laparoscopic surgery. This randomized controlled trial (RCT) aimed to evaluate the impact of LPP versus standard-pressure pneumoperitoneum (SPP) on postoperative pain and surgical outcomes during laparoscopic cholecystectomy.
Methods:
A randomized, controlled, double-blind trial was performed between November 12, 2024 and December 31, 2025. Patients scheduled for elective laparoscopic cholecystectomy (LC) were randomized into two groups: LPP group (8 mmHg) versus SPP group (14 mmHg). The primary outcome was postoperative pain assessed by the Visual Analogue Scale (VAS) at 6 hours. Secondary outcomes included operative time, analgesic consumption, postoperative nausea and vomiting (PONV), and surgical complications. Data were analyzed using an intention-to-treat approach. This trial has been registered at ClinicalTrials.gov (NCT06685250) on November 11, 2024.
Results:
One hundred sixty consecutive patients were enrolled. There was no statistically significant difference in median VAS pain scores at 6 hours (3 vs. 4; p = 0.221), 12 hours (2 vs. 3; p = 0.074), or 24 hours (1 vs. 2; p = 0.128) postoperatively. However, the mean consumption of paracetamol during the first 24 hours was significantly lower in the LPP group compared to the SPP group (1.04 ± 0.906 vs. 1.35 ± 0.873; p = 0.014). Operative times were similar (59.9 ± 27.5 vs. 58.2 ± 22.4 minutes; p = 0.880). No conversion to laparotomy or major morbidities were recorded.
Conclusion:
LPP (8 mmHg) was feasible without increasing operative duration. It did not show a statistically significant reduction in VAS pain scores at 6 hours. Larger studies are required to confirm safety equivalence regarding rare surgical complications.
