Araujo-López A, Herrera-Barrón SJ, Insunza-Miranda JG, Sierra-Brozon AG

Language: Spanish
References: 20
Page: 54-63
PDF size: 301.85 Kb.

ABSTRACT

Introduction: At present, laparoscopic cholecystectomy is considered the procedure of choice in the management of symptomatic cholelithiasis. It has been proposed that pneumoperitoneum in laparoscopic surgery increases post-surgical pain and produces adverse physiological effects in some patients. Objective: Control postoperative pain in surgery by reducing pneumoperitoneum pressure. Material and methods: Study 3 hospitals, both public and private, comparing the conventional technique using the original intra-abdominal pressure versus lowering the pneumoperitoneum pressure to 10 mmHg, to reduce pain. Results: Based in the comparison against the conventional technique with normal pressure we described a significant difference (p = 0.002) for less postoperative pain with pneumoperitoneum technique with a mean decrease of transoperatory pressure of 10.9 mmHg of CO₂. Conclusion: Reducing the CO₂  pressure in mmHg up to 10.9 on average of the transoperative pneumoperitoneum, was shown as a safe, uncomplicated pressure and reduced postoperative pain without the need to scale up a greater number of analgesics.

REFERENCES

1. Nematihonar B, Fahimihanzaei H, Kamranmanesh M, Memary E, Shahbazi A, Mirkheshti A. Comparison postoperative shoulder pain, nausea, and vomiting between low and normal pressure pneumoperitoneum in laparoscopic cholecystectomy. Annals of Anesthesiology and Critical Care. 2017; 2 (2): 149-151.

2. Gurusamy KS, Koti R, Davidson BR. Abdominal lift for laparoscopic cholecystectomy. Cochrane Database Syst Rev. 2013; (8): CD006574.

3. Strasberg SM, Brunt LM. Rationale and use of the critical view of safety in laparoscopic cholecystectomy. J Am Coll Surg. 2010; 211 (1): 132-138.

4. Koc M, Ertan T, Tez M et al. Randomized, prospective comparison of postoperative pain in low- versus high-pressure pneumoperitoneum. ANZ J Surg. 2005; 75 (8): 693-696.

5. Nasajiyan N, Javaherfourosh F, Ghomeishi A, Akhondzadeh R, Pazyar F, Hamoonpou N. Comparison of low and standard pressure gas injection at abdominal cavity on postoperative nausea and vomiting in laparoscopic cholecystectomy. Pak J Med Sci. 2014; 30 (5): 1083-1087.

6. Kar M, Kar JK, Debnath B. Experience of laparoscopic cholecystectomy under spinal anesthesia with low-pressure pneumoperitoneum: prospective study of 300 cases. Saudi J Gastroenterol. 2011; 17 (3): 203-207.

7. Vijayaraghavan N, Sistla SC, Kundra P et al. Comparison of standard-pressure and low-pressure pneumoperitoneum in laparoscopic cholecystectomy: a double blinded randomized controlled study. Surg Laparosc Endosc Percutan Tech. 2014; 24 (2): 127-133.

8. Schirmer BD, Edge SB, Dix J, Hyser MJ, Hanks JB, Jones RS. Laparoscopic cholecystectomy. Treatment of choice for symptomatic cholelithiasis. Ann Surg. 1991; 213 (6): 665-676.

9. Dexter SP, Vucevic M, Gibson J, McMahon MJ. Hemodynamic consequences of high- and low-pressure capnoperitoneum during laparoscopic cholecystectomy. Surg Endosc. 1999; 13 (4): 376-381.

10. Neudecker J, Sauerland S, Neugebauer E et al. The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery. Surg Endosc. 2002; 16 (7): 1121-1143.

11. Barczyński M, Herman RM. A prospective randomized trial on comparison of low-pressure (LP) and standard-pressure (SP) pneumoperitoneum for laparoscopic cholecystectomy. Surg Endosc. 2003; 17 (4): 533-538.

12. Serralta A, Bueno J, Sanhauja A, García R, Arnal C. Evolución del dolor postoperatorio en la colecistectomía laparoscópica bajo anestesia-analgesia multimodal en régimen ambulatorio. Rev Esp Anestesiol Reanim. 2002; 49: 461-467.

13. Dávila FSA, Chávez CRH. Dolor postoperatorio en colecistectomía laparoscópica. Ropivacaína vs placebo. Ensayo clínico. Cir Gen. 2010; 32 (2): 96-99.

14. Lucena JR. La irrigación con bupivacaína intraoperatoria en la prevención del dolor en el hombro post colecistectomía laparoscópica. Revista Multidisciplinaria del Consejo de Investigación de la Universidad de Oriente. 2005; 17 (2): 131-138.

15. Claros N, Fuentes I, Cari A, Laguna R. Omalgia asociada a neumoperitoneo a baja presión vs presión estándar durante la colecistectomía laparoscópica. Rev Med La Paz. 2010; 16 (2): 5-11.

16. López-Maya L, Lina-Manjarrez F, Díaz-Peralta A et al. Disminución del dolor postoperatorio en colecistectomía laparoscópica. Ropivacaína cutánea e intraperitoneal (antes vs después) de la incisión y neumoperitoneo. Rev Mex Anest. 2011; 34 (4): 251-259.

17. Schietroma M, Carlei F, Cecilia EM et al. A prospective randomized study of systemic inflammation and immune response after laparoscopic Nissen fundoplication performed with standard and low-pressure pneumoperitoneum. Surg Laparosc Endosc Percutan Tech. 2013; 23 (2): 189-196.

18. Basgul E, Bahadir B, Celiker V, Karagoz AH, Hamaloglu E, Aypar U. Effects of low and high intra-abdominal pressure on immune response in laparoscopic cholecystectomy. Saudi Med J. 2004; 25 (12): 1888-1891.

19. Hua J, Gong J, Yao L, Zhou B, Song Z. Low-pressure versus standard-pressure pneumoperitoneum for laparoscopic cholecystectomy: a systematic review and meta-analysis. Am J Surg. 2014; 208: 143-50.

20. Donatsky AM, Bjerrum F, Gögenur I. Surgical techniques to minimize shoulder pain after laparoscopic cholecystectomy. A systematic review. Surg Endosc. 2013; 27: 2275-2282.