The Effect of Low-Pressure Pneumoperitoneum with Active Evacuation on the Severity of Shoulder Pain in Patients Undergoing Laparoscopic Cholecystectomy

Background and Objective: Although the pain severity following laparoscopic cholecystectomy is generally lower compared to the open method, but some patients may still experience abdominal and shoulder pain for several days after the laparoscopic procedure. Based on recent evidences, pneumoperitoneum using low-pressure carbon dioxide gas can reduce the pain. This study evaluated the feedback on shoulder pain severity from laparoscopic cholecystectomy patients experiencing CO۲-pneumoperitoneum. Materials and Methods: ۸۰ laparoscopic cholecystectomy cases were allocated for intervention (n = ۴۰) and control groups (n = ۴۰) randomly. Pneumoperitoneum was done by a direct trocar. Patients’ pain feedback was assessed using the visual pain scale after the surgery. SPSS ۲۱ was used to analyze the collected data. Results: Shoulder pain frequency significantly differed between the two groups at ۱۲ hours (P = ۰.۰۴۸) and ۲۴ hours (P = ۰.۰۰۱) after the surgery. Regarding average shoulder pain severity, the groups showed significant differences after ۲, ۶, and ۲۴ hours of surgery (P < ۰.۰۵). Moreover, pneumoperitoneum duration was different in the groups (P = ۰.۰۰۱). Conclusion: Based on these findings, low pressure of pneumoperitoneum with active evacuation compared to the standard pressure, efficiently reduced shoulder pain intensity. Thus, using low-pressure pneumoperitoneum in laparoscopic cholecystectomy is recommended to relieve postoperative pain.