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 CO2-pneumoperitoneum. Materials and Methods: 80 laparoscopic cholecystectomy cases were allocated for intervention (n = 40) and control groups (n = 40) randomly. Pneumoperitoneum was done by a direct trocar. Patients’ pain feedback was assessed using the visual pain scale after the surgery. SPSS 21 was used to analyze the collected data. Results: Shoulder pain frequency significantly differed between the two groups at 12 hours (P = 0.048) and 24 hours (P = 0.001) after the surgery. Regarding average shoulder pain severity, the groups showed significant differences after 2, 6, and 24 hours of surgery (P 0.05). Moreover, pneumoperitoneum duration was different in the groups (P = 0.001). 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.