scholarly journals Correlation of shoulder tip pain in case of low pressure and standard pressure pneumoperitoneum post laparoscopic cholecystectomy

2021 ◽  
Vol 8 (5) ◽  
pp. 1522
Author(s):  
Lakshman Agarwal ◽  
Sanjay Kumawat ◽  
Sumita A. Jain ◽  
Amit Yadav ◽  
Sandeep Sharma
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Randomized Study ◽  
Visual Analogue Score ◽  
Low Pressure ◽  
P Value ◽  
Pressure Group ◽  
Group A ◽  
Standard Pressure ◽  
Group B

Background: Laparoscopic cholecystectomy is gold standard treatment for cholelithiasis now a days. Post-operative shoulder tip pain is common complain after laparoscopic cholecystectomy. The cause of this shoulder tip pain is multifactorial e.g. peritoneal stretching and diaphragmatic irritation. The main cause of this shoulder tip pain is pneumoperitoneum caused by carbon dioxide. Correlation of shoulder tip pain in case of low pressure (7-8 mmHg) and standard pressure (12-14 mmHg) pneumoperitoneum post laparoscopic cholecystectomy.Methods: A prospective randomized study was done in 100 patients of cholelithiasis in SMS hospital Jaipur Rajasthan. The patients were divided into two groups-Group A patients undergoing laparoscopic cholecystectomy at low pressure (7-8 mmHg) and group B patients undergoing laparoscopic cholecystectomy at standard pressure (12-14 mmHg). The intensity of shoulder tip pain were measured by visual analogue score at 1, 6, 12, 24 and 48 hours. In both of the group results were compared in terms of frequency of pain, intensity of pain and requirement of post-operative analgesics. The duration of hospital stay was also compared.Results: Post-operative shoulder tip was found to be less in low pressure group (group A) as compare to standard pressure group (group B). Total requirement of post-operative analgesic dose and hospital stay was also found to be less in low pressure group as compared to standard pressure group. This was statistically significant (p value<0.05).Conclusions: There is less intensity, frequency of shoulder tip pain, less post-operative analgesics requirement and less post-operative hospital stay after laparoscopic cholecystectomy done under low pressure pneumoperitoneum (7-8 mmHg).

scholarly journals Comparison of standard and low-pressure pneumoperitoneum; reduction in frequency and intensity of post-operative shoulder pain

2019 ◽  
Vol 2 (2) ◽  
pp. 47-51
Author(s):  
Sania Waseem ◽  
Humera Naz Altaf ◽  
Sehrish Latif ◽  
Omar Shahzad Altaf ◽  
Fareeha Farooqui ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Abdominal Cavity ◽  
Low Pressure ◽  
Intraabdominal Pressure ◽  
P Value ◽  
Reduced Pressure ◽  
Quasi Experimental ◽  
Group A ◽  
Standard Pressure ◽  
Group B

Laparoscopic cholecystectomy is now gold standard and depends on good exposure of the peritoneal cavity. It is achieved by insufflation of the abdominal cavity with CO2. Operating at lower intraabdominal pressure (<12 -15mmHg) has been associated with fewer pulmonary and hemodynamic complications and lesser postoperative pain. Objective: To ascertain the advantages of low pressure pneumoperitoneum over standard pressure pneumoperitoneum Methods: Our study was quasi experimental study conducted at  KRL Hospital, Islamabad over period of 3years from 2013 to 2016. SPSS version 20 was used to calculate p value.  Results: A total of 456 patients of gallstones were equally divided in two groups assigned to undergo low pressure (7-8mm of Hg) pneumoperitoneum or standard pressure (12-14mm of Hg) pneumoperitoneum laparoscopic cholecystectomy The average age of patients was 46.2+/-13.6yrs in group A compared to 43.5 +/- 12.9 in group B. There were 60 (26.3%) male and 168 (73.7%) female patients in group A compared to 53 (23.2% and 175 (76.85) in group B respectively. It was found that group A 14 (6.1%) had no pain, 26 (11.4%) had VAS between 1 – 7 and 188 (82.5%) had VAS of 8 – 10 where as in group B 164 (72.6%) patients reported no shoulder tip pain postoperatively, 42 (18.6%) had VAS of 1 – 7 and 20 (8.8%) had VAS OF 8 – 10. The difference was statistically significant (p-value = <0.001). Conclusions: reduced pressure of pneumoperitoneum to 7 – 8 mm of Hg produce lower incidence of postoperative shoulder tip pain.

scholarly journals 975 Outcome of Low Verus Standard Pressure Pneumoperitoneum in Laparoscopic Cholecystectomy: A Randomized Trial

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
H Anwaar ◽  
R Ahmed ◽  
Z Hashmi ◽  
Q Qavi ◽  
T Zafar
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Randomized Trial ◽  
Operative Time ◽  
Low Pressure ◽  
P Value ◽  
Group A ◽  
Standard Pressure ◽  
Group B

Abstract Introduction Recent studies have shown that patients may experience considerable pain after laparoscopic cholecystectomy as well. Hence, this study was done to compare results on post op pain with low pressure pneumoperitoneum compared with standard pneumoperitoneum. Method 100 patients were selected for study and equally divided in two groups randomized into Low pressure (n = 50) and Standard pressure (n = 50). Operative time (min), postoperative pain (VAS) and frequency of Shoulder Tip Pain was noted in both groups Results A total of 100 patients were enrolled for this study. Patients were divided into two groups i.e. Group-A (Standard pressure) and Group-B (Low pressure). In group-A, there were 35(70%) males and 15(30%) females, while in group-B, there were 41(82%) males and 9(18%) females. Mean age of group-A patients was 42.0±7.0 years and 44.5±8.1 years in group-B. In group-A, 18(36%) patients had shoulder tip pain, while 4(8%) patients had had shoulder tip pain in group-B patients with a p-value of 0.001, which is statistically significant. Conclusions Laparoscopic cholecystectomy using low pressure pneumoperitoneum is feasible and results in less post-operative shoulder tip pain.

EVALUATION OF POSTOPERATIVE SHOULDER TIP PAIN IN LOW PRESSURE VERSUS STANDARD PRESSURE PNEUMOPERITONEUM DURING LAPAROSCOPIC CHOLECYSTECTOMY

2021 ◽  
pp. 28-29
Author(s):  
Om Prakash Pawar ◽  
Ranjana Sinha
Keyword(s):  
Carbon Dioxide ◽  
Laparoscopic Cholecystectomy ◽  
Low Pressure ◽  
Postoperative Rehabilitation ◽  
Diaphragmatic Muscle ◽  
Group A ◽  
Standard Pressure ◽  
The Mean ◽  
Group B ◽  
Postoperative Shoulder

Introduction:- Insufation of carbon dioxide during laparoscopic cholecystectomy carries on to postoperative shoulder tip pain. The beginning of shoulder pain is commonly presumed to be due to overstretching of the diaphragmatic muscle bres due to high carbon dioxide pressure. Methods: - Patients came and admitted to the surgery department for elective cholecystectomy were enrolled in the study. The patients were randomly divided in two groups (group A and group B). In group A - low-pressure pneumoperitoneum (8 mm Hg) and in group B- standard pressure pneumoperitoneum (14 mm Hg) was created during laparoscopic cholecystectomy. Postoperative shoulder tip pain was evaluated at 4 hours and 24 hours after the operation. Results:- Fourteen patients or 28 % of patients in group B complained of postoperative shoulder tip pain as collated to only ve patients (10%) in group A. The mean intensity of postoperative shoulder tip pain assessed by the visual analogue scoring scale at 4 hours and 24 hours was less in group A as collated to group B. However, statistical signicance was seen only at four hours. Analgesic requirements and the mean length of postoperative stay in the hospital were minor in group-A as collated to group B. Conclusion: - Low-pressure laparoscopic cholecystectomy signicantly reduces the frequency and intensity of postoperative shoulder tip pain. Low-pressure laparoscopic cholecystectomy decreases the demand for postoperative analgesics, decreases postoperative hospital stay, and improves the quality of life in the initial stage of postoperative rehabilitation.

scholarly journals Comparative evaluation of hemodynamic and capnographic changes in low pressure versus normal pressure pneumoperitoneum in laparoscopic cholecystectomy

2017 ◽  
Vol 4 (8) ◽  
pp. 2642
Author(s):  
Shailendra Pal Singh ◽  
Shashank Verma ◽  
Anand Pandey ◽  
Usha Shukla ◽  
Vipin Gupta ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Laparoscopic Cholecystectomy ◽  
Normal Pressure ◽  
Low Pressure ◽  
Abdominal Pressure ◽  
Group A ◽  
Standard Pressure ◽  
Group B ◽  
Control Study ◽  
Mean Heart Rate

Background: In laparoscopic cholecystectomy (LC), the extent of hemodynamic changes associated with creation of pneumoperitoneum depends on the intra-abdominal pressure attained, volume of CO2 absorbed, and patient’s intravascular volume. In our study, we attempted to compare the hemodynamic and capnographic changes in the low pressure (<8mm Hg) and standard pressure (12-14mm Hg) LC.Methods: In this randomized case control study, Group A included patients undergoing Low pressure LC (<8mm Hg). In group B, Standard pressure LC (12-14mmHg) was performed. Both groups were evaluated for the hemodynamic and capnographic changes and other parameters.Results: Difference in mean heart rate of Group A and Group B was found to be statistically significant at 10 min after induction. After 30 minutes of surgery, systolic blood pressure of Group B was found to be higher than that of Group A (p <0.05). Differences in diastolic blood pressure among patients of Group A and Group B were found to be statistically significant only at 30 min and 40 min after induction. Except at 30 min after induction, differences in EtCO2 levels of patients of Group A and Group B were found to be statistically significant.Conclusions: It appears that low pressure pneumoperitoneum appears to be having fewer effects on blood pressure- both systolic and diastolic, as compared to standard pressure pneumoperitoneum in patients undergoing LC. It also appears to be causing fewer derangements in ETCO2. This may help in smooth recovery and less post-operative problems.

scholarly journals BENEFITS OF EARLY POST-ERCP LAPAROSCOPIC CHOLECYSTECTOMY: A SINGLE CENTRE PROSPECTIVE STUDY

2021 ◽  
Vol 12 (3) ◽  
Author(s):  
Farhan javed ◽  
Saira Saleem ◽  
Ayesha Rehman ◽  
Faiza Wattoo ◽  
Nadia Bano ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Operative Time ◽  
Statistical Tests ◽  
P Value ◽  
Cross Sectional ◽  
Increased Risk ◽  
Group A ◽  
Study Population ◽  
Group B

ABSTRACT: BACKGROUND & OBJECTIVE: Laparoscopic cholecystectomy (LC) following Endoscopic retrograde cholangiopancreatography (ERCP) is associated with an increased risk of complications. ERCP is associated with increased incidence of complications during LC. Surgery may be performed in same anesthesia with ERCP or up to 6 weeks later. We aimed to determine the benefits of performing LC within 72hrs of ERCP. METHODOLOGY: After institutional ethical approval this prospective cross-sectional study was performed at Madinah Teaching Hospital Faisalabad from April 2019 to June 2020. By performing convenience sampling, all patients undergoing LC after uneventful ERCP in our hospital were included. Study population was divided based on interval between ERCP and Cholecystectomy; Group-A had LC within 72hrs of ERCP, Group B had LC in same hospital stay after 72hrs and Group-C patients were discharged after ERCP and readmitted for LC. Data was collected using custom designed questionnaire, tabulated using Microsoft Excel 2016 and subjected to statistical tests to compare outcomes. Primary outcome was incidence of complications, while operative time, hospital stay and cost were considered as secondary outcomes. p-value of <0.05 was considered significant. RESULTS: Total 75 patients were included in study, 32 in Group-A, 20 in Group-B and 23 in Group-C. Average age was 44.987 ± 14.819 and study population was predominantly female (86.67%). Complication rate, duration of hospital stay and average cost were less in Group A as compared to other groups (p<0.05). Mean operative time in 3 groups was similar. CONCLUSION: LC within 72hrs after ERCP provides superior results in terms of fewer complications, shorter hospital stays and lesser cost.

scholarly journals Evaluation of superiority of preemptive analgesia with instillation of 0.5% bupivacaine before rather than after surgery for laparoscopic cholecystectomy

2019 ◽  
Vol 6 (5) ◽  
pp. 1589
Author(s):  
Manoj A. Vasava ◽  
Jay M. Makadia
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Visceral Pain ◽  
Randomized Study ◽  
Length Of Hospital Stay ◽  
Preemptive Analgesia ◽  
Muscular Tissue ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B

Background: The objective of the study was to evaluate the superiority of preemptive analgesia with instillation of 0.5% bupivacaine before rather than after surgery for laparoscopic cholecystectomy.Methods: A prospective, randomized study of 264 patients in whom laparoscopic Cholecystectomy (LC) was conducted in the department of General Surgery at the SSG and Medical College Baroda during a period of 25 months from October 2010 to October 2012. Randomization was done with prepared close enveloped which randomly allocate the patient in either group A or B. Data collected from each patient were: age, sex, ASA score, hospital stay, duration of surgery, no of trocar used, first request for analgesics, vomiting, duration of surgery, intraperitoneal drain was kept or not , length of hospital stay, any other postoperative complication.Results: During the period of 24 months total 264 patients were undergone cholecystectomy. On comparison between Group A and B, data shows that the mean  VAS is less at all assessment (4, 8 & 24 hrs) for Group A as compared to Group B. Mean parietal pain score VAS is less for Group B as compared to Group A at all assessments.Conclusions: Use of bupivacaine in optimal dose in GB bed reduced the visceral pain and use in skin, SC tissue, muscular tissue reduced the parietal pain. Use of bupivacaine before GB removal is much more cost effective than after removal of GB.

scholarly journals Comparative Study of Low Pressure versus Standard Pressure Carbon Dioxide Pneumoperitoneum in Reducing Shoulder Tip Pain Post Laparoscopic Cholecystectomy

2022 ◽  
Vol 19 (1) ◽  
pp. 9-12
Author(s):  
Pradip Thapa ◽  
Divas Thapa ◽  
Anup Sharma
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Intraoperative Complications ◽  
Low Pressure ◽  
Satisfaction Score ◽  
Pressure Group ◽  
Conversion To Open Cholecystectomy ◽  
Procedural Time ◽  
Standard Pressure ◽  
The Impact

Introduction: Laparoscopic cholecystectomy is the gold standard treatment for cholelithiasis. Postoperative shoulder tip pain is common complaint. Evidences suggest that using low pressure pneumoperitoneum (8-10 mmHg) during the procedure rather than standard pressure (12-14 mmHg) decreases the incidence and severity of shoulder tip pain without compromising working space. Aims: The aim of this study was to evaluate the impact of low pressure and standard pressure pneumoperitoneum on shoulder tip pain post laparoscopic cholecystectomy. Methods: A prospective hospital based study conducted at Nepalgunj Medical College, Kohalpur from January 2019 to December 2020. Hundred patients were enrolled, fifty each in “low pressure carbondioxide pneumoperitoneum” and “standard pressure carbondioxide pneumoperitoneum” groups, who underwent laparoscopic cholecystectomy. The two groups were compared in terms of incidence and severity of shoulder tip pain, surgeon’s satisfaction score, top-up analgesia requirement, procedural time, conversion to standard pressure, intraoperative complications and length of hospital stay. Results: There were 45 (90%) females and five (10%) males in low pressure group and 44 (88%) females and six (12%) males in standard pressure group. Fourteen (28%) patients in low pressure and 32 (64%) patients in standard pressure group had shoulder tip pain (p=0.001). The severity of shoulder tip pain was less in low pressure group and was significant at eight hours (p=0.006) and 12 hours (p=0.008). Top-up analgesia was required more in standard pressure group. There were no intraoperative complications but only one conversion to standard pressure. Surgeon’s satisfaction score, conversion to open cholecystectomy and procedural time were comparable in both groups with shorter hospital stay in low pressure group. Conclusion: Low pressure carbondioxide pneumoperitoneum is safe and effective strategy in reducing incidence and severity of shoulder tip pain after laparoscopic cholecystectomy.

scholarly journals A comparative study of the incidence of pain and infection in gall bladder extraction via umbilical and epigastric port

2017 ◽  
Vol 4 (2) ◽  
pp. 747 ◽  
Author(s):  
Jugendra Pal Singh Shakya ◽  
Neelabh Agrawal ◽  
Arun Kumar ◽  
Akash Singh ◽  
Bhupesh Gogia ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Randomized Study ◽  
Port Site ◽  
P Value ◽  
Medical College ◽  
Post Operative Pain ◽  
Group A ◽  
The Difference ◽  
Group B

Background: In laparoscopic cholecystectomy, gall bladder extraction via different ports has always been a matter of concern for the surgeons. This study is designed so as to determine the difference in the rate of pain and infection in gall bladder extraction via umbilical and epigastric port.Methods: A prospective randomized study was done from January 2015 to December 2015 at S. N. Medical College, Agra in which 200 patients of cholelithiasis were considered. The patients were randomly selected in the operation theatre for gall bladder extraction via epigastric port (designated as Group-A with n = 100 patients) and gall bladder extraction via umbilical port (designated as Group-B with n = 100 patients).Results: Post-operative pain at 24 hours, in terms of VAS was 3.67±1.42 in Group-A while 2.47±1.17 in Group-B with 10 being the worst pain. The p-value was calculated as .000048. The result is significant at p< .05. A total of eight patients out of two hundred patients suffered port site infections amongst which five were from Group-A (5%) and three were from Group-B (3%).Conclusions: This study thus indicates that in laparoscopic cholecystectomy, gall bladder retrieval through the umbilical port is a better alternative to gall bladder extraction via epigastric port in terms of post-operative pain and port site infection. Our study recommends gall bladder extraction via umbilical port rather than epigastric port. 

scholarly journals ELECTIVE MIDLINE LAPAROTOMY

2011 ◽  
Vol 18 (01) ◽  
pp. 106-111
Author(s):  
ARSALAN SIRAJ ◽  
ATHAR ABBAS SHAH GILANI ◽  
MUHAMMAD FAROOQ DAR ◽  
Sohail Raziq
Keyword(s):  
Postoperative Pain ◽  
Blood Loss ◽  
Wound Infection ◽  
Visual Analogue Score ◽  
P Value ◽  
Midline Laparotomy ◽  
Pain Scores ◽  
Group A ◽  
Insignificant Difference ◽  
Group B

Objectives: To compare the diathermy incision with scalpel incision in patients undergoing midline elective laparotomy. Design of Study: A prospective, experimental comparative study. Place and Duration: Department of surgery, PNS Shifa Karachi, from March 2007 to June 2008. Patients and Methods: A total of 100 patients were included in the study, and equally divided into 2 groups. Group A received scalpel incision while in group B diathermy was employed to incise all layers. Peroperative parameters including, incision time and blood loss were calculated. Postoperatively, pain was assessed by visual analogue score and wound infection documented. Results: Both groups included fifty patients each out of the total 44 females and 56 were males, with similar gender preposition in both the groups. Mean age of patients in scalpel group was 48.78 (±14.47) while it was 44.92 (±15.87) in diathermy group. The mean incision related blood loss in Scalpel group was 1.53 (±0.20) ml/cm2 and in Diathermy group was 1.43 (±0.20) ml/cm2, showing significantly less bleeding in diathermy group (p-value= 0.014). Diathermy group, with incision related time of 6.20 sec/cm2 (±0.97 sec/cm2), was significantly quicker (p-value= 0.003) than scalpel incision, with incision time of 6.76 sec/cm2 (±0.84 sec/cm2). Postoperative pain scores, recorded daily over five days, showed insignificant difference between the two groups. Conclusions: Diathermy, employed for midline laparotomy, is quicker and hemostatic, compared to the scalpel. The two are, however, similar in terms of wound infection and postoperative pain.

scholarly journals A comparative study of open cholecystectomy and laparoscopic cholecystectomy in patients with cholelithiasis

2017 ◽  
Vol 5 (1) ◽  
pp. 253 ◽  
Author(s):  
Pramod Singh ◽  
Sumit Kumar Gupta ◽  
Mukesh Kumar
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Surgical Site Infection ◽  
Hospital Stay ◽  
Open Cholecystectomy ◽  
City Hospital ◽  
Site Infection ◽  
First Choice ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B

Background: Cholelithiasis is a major cause of morbidity among Indians with a female preponderance. Most of the cases of gallstones are asymptomatic. For a long time, open cholecystectomy (OC) used to be the surgical treatment for cholelithiasis. But with the advent of laparoscopic cholecystectomy (LC) there has been a gradual shift in the treatment with most surgeons preferring LC over OC. Apart from the benefits of decreased hospital stay, lesser postoperative pain and earlier return to normal activity LC are also cosmetically better as compared to OC. Longer operative time and increased incidence of biliary leakage are some pitfalls of LC in initial phase of surgical practice.Methods: A prospective study of 100 patients was carried out in the department of surgery in IQ city medical college and Durgapur city hospital, Durgapur between January 2017 and August 2017 with the aim of comparing open cholecystectomy with laparoscopic cholecystectomy. The patients were randomly assigned into two groups. Group A consisted of patients who underwent laparoscopic surgery while Group B patients underwent open surgery for cholelithiasis.Results: Duration of surgery was longer in OC than LC (72.4min versus 44.7min.). Mean duration of post-operative pain was 18.3hrs in group A as compared to mean duration of 30.7hrs in group B patients. The mean period of post-operative hospital stay was 1.8 days in group A and 4.8 days in group B. Post-operative resumption of normal diet was possible in 2.1 days in OC while it took lesser time (1.2 days) in LC. The rate of surgical site infection was higher in OC as compared to LC.Conclusions: Laparoscopic cholecystectomy can be recommended as first choice operative treatment for patients with cholelithiasis as it provides better cosmetic results, lesser pain, lesser post-operative hospital stay and fewer incidence of surgical site infection.

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