Use of intraoperative mild hyperventilation to decrease the incidence of postoperative shoulder pain after laparoscopic gastric sleeve surgery: A prospective randomised controlled study

Adel M Bataineh, Ibraheem Y Qudaisat, Mohammed Banihani, Rawan Obeidat, Heba S Hamasha, Adel M Bataineh, Ibraheem Y Qudaisat, Mohammed Banihani, Rawan Obeidat, Heba S Hamasha

Abstract

Background and aims: Post-laparoscopic shoulder pain (PLSP) is a common problem. It is a referred type of pain resulting from irritation of phrenic nerve endings. Multiple manoeuvres were used to decrease its incidence with varying success rates. In this study, we tested the use of mild intraoperative hyperventilation to reduce PLSP in patients undergoing laparoscopic sleeve gastrectomy surgery (LSG).

Methods: Consenting American Society of Anesthesiologists-I and II patients undergoing LSG under general anaesthesia were randomly assigned to two groups. Group A (53 patients) received intraoperative mild hyperventilation with target end-tidal carbon dioxide (ETCO2) of 30-32 mmHg. Group B (51 patients) received conventional ventilation (ETCO2 of 35-40 mmHg). Incidence and severity of PLSP, cumulative analgesic requirements and incidence of nausea and vomiting were recorded at 12 and 24 hours postoperatively and then followed up after discharge over the phone at 48 hours, 1 week, 1 month and 3 months. Statistical significance of differences between the two groups was defined at P < 0.05.

Results: Incidence of PLSP was comparable between the two groups in the first 24 hours. The intervention group had a significantly lower incidence of PLSP throughout the remaining assessment points (56.6% vs. 80.4%, 30.2% vs. 78.4%, 15.1% vs. 70.6%, 3.8% vs. 35.3% at 36 hours, 48 hours, 1 week and 1 month, respectively, P < 0.05). The average PLSP pain score was significantly lower in the mild hyperventilation group at all assessment time points. Nausea and vomiting were non-significantly lower in the mild hyperventilation group.

Conclusion: Mild intraoperative hyperventilation could be beneficial in reducing the incidence and severity of PLSP after LSG surgery.

Keywords: Bariatric surgery; hyperventilation; laparoscopy; pain; shoulder.

Conflict of interest statement

There are no conflicts of interest.

Copyright: © 2021 Indian Journal of Anaesthesia.

Figures

Figure 1
Figure 1
Flow diagram of patients' enrolment, randomisation, and follow-up
Figure 2
Figure 2
Cumulative paracetamol consumption (gm) by study patients

References

    1. Rubinstein LM, Lebherz TB, Kleinkopf V. Laparoscopic tubal sterilization: Long-term postoperative follow-up. Contraception. 1976;13:631–8.
    1. Alexander JI. Pain after laparoscopy. Br J Anaesth. 1997;79:369–78.
    1. Donatsky AM, Bjerrum F, Gögenur I. Surgical techniques to minimize shoulder pain after laparoscopic cholecystectomy.A systematic review. Surg Endosc. 2013;27:2275–82.
    1. Wills VL, Hunt DR. Pain after laparoscopic cholecystectomy. Br J Surg. 2000;87:273–84.
    1. Kandil TS, Hefnawy E El. Shoulder pain following laparoscopic cholecystectomy: factors affecting the incidence and severity. J Laparoendosc Adv Surg Tech. 2010;20:677–82.
    1. Mouton WG, Bessell JR, Otten KT, Maddern GJ. Pain after laparoscopy. Surg Endosc. 1999;13:445–8.
    1. Sao C-H, Chan-Tiopianco M, Chung K-C, Chen Y-J, Horng H-C, Lee W-L, et al. Pain after laparoscopic surgery: Focus on shoulder-tip pain after gynecological laparoscopic surgery. J Chinese Med Assoc. 2019;82:819–26.
    1. Dixon JB, Reuben Y, Halket C, O'Brien PE. Shoulder pain is a common problem following laparoscopic adjustable gastric band surgery. Obes Surg. 2005;15:1111–7.
    1. Phelps P, Cakmakkaya OS, Apfel CC, Radke OC. A simple clinical maneuver to reduce laparoscopy-induced shoulder pain: a randomized controlled trial. Obstet Gynecol. 2008;111:1155–60.
    1. Kim B, Kim J, Park I, Cho H, Gwak G, Yang KH, et al. unmodifiable clinicopathological risk factors of shoulder tip or subcostal pain after laparoscopic appendectomy. J Minim Invasive Surg. 2020;23:43–8.
    1. Jorgensen JO, Gillies RB, Hunt DR, Caplehorn JRM, Lumley T. A simple and effective way to reduce postoperative pain after laparoscopic cholecystectomy. ANZ J Surg. 1995;65:466–9.
    1. Pasquier EK, Andersson E. Pulmonary recruitment maneuver reduces pain after laparoscopic bariatric surgery: A randomized controlled clinical trial. Surg Obes Relat Dis. 2018;14:386–92.
    1. Slim K, Bousquet J, Kwiatkowski F, Lescure G, Pezet D, Chipponi J. Effect of CO2 gas warming on pain after laparoscopic surgery. Surg Endosc. 1999;13:1110–4.
    1. Sarli L, Costi R, Sansebastiano G, Trivelli M, Roncoroni L. Prospective randomized trial of low-pressure pneumoperitoneum for reduction of shoulder-tip pain following laparoscopy. Br J Surg. 2000;87:1161–5.
    1. Koivusalo AM, Kellokumpu I, Lindgren L. Gasless laparoscopic cholecystectomy: Comparison of postoperative recovery with conventional technique. Br J Anaesth. 1996;77:576–80.
    1. Phinchantra P, Bunyavehchevin S, Suwajanakorn S, Wisawasukmongchol W. The preemptive analgesic effect of celecoxib for day-case diagnostic laparoscopy. J Med Assoc Thai. 2004;87:283–8.
    1. Jain S, Nazir N, Singh S, Sharma S. A prospective randomised controlled study for evaluation of high-volume low-concentration intraperitoneal bupivacaine for post- laparoscopic cholecystectomy analgesia. Indian J Anaesth. 2018;62:109.
    1. Putta P, Pasupuleti H, Samantaray A, Natham H, Rao M. A comparative evaluation of pre-emptive versus post-surgery intraperitoneal local anaesthetic instillation for postoperative pain relief after laparoscopic cholecystectomy: A prospective, randomised, double blind and placebo controlled study. Indian J Anaesth. 2019;63:205–11.
    1. Shukla U, Prabhakar T, Malhotra K, Srivastava D, Malhotra K. Intraperitoneal bupivacaine alone or with dexmedetomidine or tramadol for post-operative analgesia following laparoscopic cholecystectomy: A comparative evaluation. Indian J Anaesth. 2015;59:234–9.
    1. Kaarthika T, Radhapuram S, Samantaray A, Pasupuleti H, Hanumantha Rao M, Bharatram R. Comparison of effect of intraperitoneal instillation of additional dexmedetomidine or clonidine along with bupivacaine for post-operative analgesia following laparoscopic cholecystectomy. Indian J Anaesth. 2021;65:533–8.
    1. Elsakka A, Elrefai N, Shehata J, Abdel Mawla A. Postoperative analgesic efficacy of the pulmonary recruitment manoeuvre compared to intraperitoneal hydrocortisone in laparoscopic gynaecological surgeries. Indian J Anaesth. 2021;65:115–20.
    1. Ghodki P, Sardesai S, Thombre S. Evaluation of the effect of intrathecal clonidine to decrease shoulder tip pain in laparoscopy under spinal anaesthesia. Indian J Anaesth. 2010;54:231–4.
    1. Son J-S, Oh J-Y, Ko S. Effects of hypercapnia on postoperative nausea and vomiting after laparoscopic surgery: A double-blind randomized controlled study. Surg Endosc. 2017;31:4576–82.
    1. Odom-Forren J, Rayens MK, Gokun Y, Jalota L, Radke O, Hooper V, et al. The relationship of pain and nausea in postoperative patients for 1 week after ambulatory surgery. Clin J Pain. 2015;31:845–51.
    1. Magarian GJ, Mazur DJ. The hyperventilation challenge test. Chest. 1991;99:199–204.
    1. Pramod K, Pal RC. Breathing and the nervous system. In: Aminoff MJ, Josephson SA, editors. Neurology and General Medicine. 5th ed. London: Elsevier; 2014. pp. 3–23.
    1. Laffey JG, Kavanagh BP. Hypocapnia. N Engl J Med. 2002;347:43–53.
    1. Satoh K, Ohashi A, Kumagai M, Sato M, Kuji A, Joh S. Evaluation of differences between PaCO2 and EtCO2 by age as measured during general anesthesia with Patients in a supine position. J Anesthesiol. 2015;2015:1–5.
    1. Warner KJ, Cuschieri J, Copass MK, Jurkovich GJ, Bulger EM. The impact of prehospital ventilation on outcome after severe traumatic brain injury. J Trauma Inj Infect Crit Care. 2007;62:1330–8.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する