Maneuvers to Reduce Laparoscopic Pain

Optimal Maneuver to Reduce Postoperative Pain Following Elective Laparoscopic Surgeries

Laparoscopic surgery has revolutionized surgical care by reducing morbidity and improving post operative recovery. Laparoscopic surgery involves the use of carbon dioxide for insufflation to achieve optimal visualization. There is literature that demonstrates higher insufflation pressures being associated with increased postoperative pain - particularly shoulder pain - and opioid use1-3. The ideal amount of intraperitoneal pressure is still under debate as other studies demonstrate that reduced pneumoperitoneum insufflation has also shown to negatively impact surgeon satisfaction and trended with longer operative time and greater blood loss without impacting pain4.

Residual intraperitoneal carbon dioxide can also contribute to postoperative discomfort. Studies have shown the effectiveness of various maneuvers in removing residual gas to reduce postoperative pain, such as intraperitoneal saline instillation5, pulmonary recruitment6,7, and gas aspiration via smoke evauator8.

Despite these advantages, there is a lack of a clear consensus on the optimal method for reducing residual intraperitoneal gas. Conversely, literature has mixed results regarding the true significance in pain reduction3,5,9.

Given the importance of minimizing postoperative pain, reducing opioid requirements, and shortening postoperative recovery time, we propose a prospective, patient-blinded, randomized controlled trial. We aim to investigate whether active gas removal via a smoke evacuator, multiple breath recruitment maneuvers, or no intervention would contribute to lowest postoperative pain. We hope our findings will help identify the most effective method for reducing residual pneumoperitoneum-related pain and thus inform surgical practices and improve patient outcomes.

Study Overview

• Status: Not yet recruiting
• Conditions: Laparoscopic Surgery; Pneumoperitoneum; Post Operative Pain, Acute
• Intervention / Treatment: Procedure: We aim to investigate whether active gas removal via a smoke evacuator or multiple breath recruitment maneuvers, improve pain compared to no intervention.

• Study Type: Interventional
• Enrollment (Estimated): 150
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Michigan
    • Detroit, Michigan, United States, 48202
      • Henry Ford Hospital
      • Contact: Ilinca Lupea, MD; Phone Number: 3134254567; Email: ilupea1@hfhs.org
      • Principal Investigator: Ilinca Lupea, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Patients age 18 to 65
• Benign, elective laparoscopic surgeries

Exclusion Criteria:

• Ages <18 and age >65
• Emergency or urgent surgeries
• Surgeries for chronic pelvic pain, malignancy
• Surgeries during pregnancy
• Severe cardiopulmonary disease
• Prior extensive abdominal surgeries (more than 2 abdominal or pelvic surgeries)
• Inability to consent

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Smoke Evacuation Group; Active gas removal via smoke evacuator for 30 seconds at the end of case	Procedure: We aim to investigate whether active gas removal via a smoke evacuator or multiple breath recruitment maneuvers, improve pain compared to no intervention.; the importance of minimizing postoperative pain, reducing opioid requirements, and shortening postoperative recovery time, we propose a prospective, patient-blinded, randomized controlled trial. We aim to investigate whether active gas removal via a smoke evacuator, multiple breath recruitment maneuvers, or no intervention would contribute to lowest postoperative pain. We hope our findings will help identify the most effective method for reducing residual pneumoperitoneum-related pain and thus inform surgical practices and improve patient outcomes.
Experimental: Recruitment Breath Group; Repeated pulmonary inflation maneuvers: 3 consecutive manual ventilations at maximum of 30 cm H2O at the end of case	Procedure: We aim to investigate whether active gas removal via a smoke evacuator or multiple breath recruitment maneuvers, improve pain compared to no intervention.; the importance of minimizing postoperative pain, reducing opioid requirements, and shortening postoperative recovery time, we propose a prospective, patient-blinded, randomized controlled trial. We aim to investigate whether active gas removal via a smoke evacuator, multiple breath recruitment maneuvers, or no intervention would contribute to lowest postoperative pain. We hope our findings will help identify the most effective method for reducing residual pneumoperitoneum-related pain and thus inform surgical practices and improve patient outcomes.
Placebo Comparator: Control Group; Passive desolation of the pneumoperitoneum at the end of the laparoscopic surgery	Procedure: We aim to investigate whether active gas removal via a smoke evacuator or multiple breath recruitment maneuvers, improve pain compared to no intervention.; the importance of minimizing postoperative pain, reducing opioid requirements, and shortening postoperative recovery time, we propose a prospective, patient-blinded, randomized controlled trial. We aim to investigate whether active gas removal via a smoke evacuator, multiple breath recruitment maneuvers, or no intervention would contribute to lowest postoperative pain. We hope our findings will help identify the most effective method for reducing residual pneumoperitoneum-related pain and thus inform surgical practices and improve patient outcomes.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Post operative pain	Post-operative pain: Patients will be assessed using the Numeric Rating Scale (NRS) by rating their pain on a scale from 0 (no pain) to 10 (worst pain imaginable) immediately prior to leaving the post-anesthesia care unit, on post-operative day 2, and post-operative day 7.	From enrollment until 1 week post surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Opioid use for the management of post operative pain	Opioid use: Patients will be asked how many of the opioid pain medication pills they were discharged with were consumed, at either their 2-week post-operative in-person visit or phone call question. Patients will be instructed to either count the number of pills that were taken or bring the bottle to their visit.	Time of enrollment until their post operative appointment up to 2 weeks from the time of surgery

Collaborators and Investigators

• Sponsor: Henry Ford Health System

Study record dates

Study Major Dates

• Study Start (Estimated): July 10, 2026
• Primary Completion (Estimated): August 1, 2028
• Study Completion (Estimated): November 1, 2028

Study Registration Dates

• First Submitted: May 6, 2026
• First Submitted That Met QC Criteria: May 6, 2026
• First Posted (Actual): May 13, 2026

Study Record Updates

• Last Update Posted (Actual): May 13, 2026
• Last Update Submitted That Met QC Criteria: May 6, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Postoperative Complications; Pathologic Processes; Digestive System Diseases; Peritoneal Diseases; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain, Postoperative; Pneumoperitoneum
• Other Study ID Numbers: 18542-01

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; ANALYTIC_CODE; CSR

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No