Reduced Laparoscopic Intra-abdominal Pressure During Laparoscopic Cholecystectomy and Its Effect on Post-operative Pain: a Double-Blinded Randomised Control Trial.

Autor: Gin E; Department of Surgery, Northern Health, 185 Cooper St, Epping, VIC, Australia., Lowen D; Department of Anaesthetics, Northern Health, Epping, Australia., Tacey M; Department of Research, Northern Health, Epping, Australia.; Department of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia., Hodgson R; Department of Surgery, Northern Health, 185 Cooper St, Epping, VIC, Australia. russell.hodgson@nh.org.au.; Department of Surgery, University of Melbourne, Epping, Australia. russell.hodgson@nh.org.au.
Jazyk: angličtina
Zdroj: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract [J Gastrointest Surg] 2021 Nov; Vol. 25 (11), pp. 2806-2813. Date of Electronic Publication: 2021 Feb 09.
DOI: 10.1007/s11605-021-04919-0
Abstrakt: Background: Laparoscopic surgery is regarded as the gold standard for the surgical management of cholelithiasis. To improve post-operative pain, low-pressure laparoscopic cholecystectomies (LPLC) have been trialed. A recent systematic review found that LPLC reduced pain; however, many of the randomised control trials were at a high risk of bias and the overall quality of evidence was low.
Methods: One hundred patients undergoing elective laparoscopic cholecystectomy were randomised to a LPLC (8 mmHg) or a standard pressure laparoscopic cholecystectomy (12 mmHg) (SPLC) with surgeons and anaesthetists blinded to the pressure. Pressures were increased if vision was compromised. Primary outcomes were post-operative pain and analgesia requirements at 4-6 h and 24 h.
Results: Intra-operative visibility was significantly reduced in LPLC (p<0.01) resulting in a higher number of operations requiring the pressure to be increased (29% vs 8%, p=0.010); however, there were no differences in length of operation or post-operative outcomes. Pain scores were comparable at all time points across all pressures; however, recovery room fentanyl requirement was more than four times higher when comparing 8 to 12 mmHg (12.5mcg vs 60mcg, p=0.047). Nausea and vomiting was also higher when comparing these pressures (0/36 vs 7/60, p=0.033). Interestingly, when surgeons estimated the operating pressure, they were correct in only 69% of cases.
Conclusion: Although pain scores were similar, there was a significant reduction in fentanyl requirement and nausea/vomiting in LPLC. Although LPLC compromised intra-operative visibility requiring increased pressure in some cases, there was no difference in complications, suggesting LPLC is safe and beneficial to attempt in all patients.
Trial Registration: Registered with the Australia and New Zealand Clinical Trials Registry (ACTRN12619000205134).
(© 2021. Crown.)
Databáze: MEDLINE
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