Effect of intra-abdominal pressure on post-laparoscopic cholecystectomy shoulder tip pain: A randomized control trial

Objective: To compare the effect of intra-abdominal pressure on postoperative shoulder-tip pain in laparoscopic cholecystectomy. Methods: This was a randomized control study, conducted at Lady Reading Hospital Peshawar from January to August 2013 on 160 patients, randomized to two groups i.e. the low pressure (LPLC) and the standard pressure group (SPLC) where the intra abdominal pressures were kept 10mmHg and above 10mmHg during surgery respectively. The age, gender, weight, duration of surgery, postoperative pain and frequency of analgesic administration in first 24 hours recorded and analyzed using Statistical Package for Social Sciences v20.0. Frequency and percentages were calculated for categorical while mean +/- SD was calculated for continuous variables. P-value of <0.05 was considered significant. Results: The mean operative times in group A and B were 27.84 +/- 6.078 vs. 28.51 +/- 7.45 minutes (p-value=0.625) respectively. Overall, the shoulder tip pain was reported in 25 (15%) patients. The frequencies in group A and B were 6 (7.5%) vs. 19 (23.8%) respectively (p-value = 0.005). The mean intensity of pain on VAS was 0.28 +/- 0.90 vs. 1.31 +/- 2.38 in the two groups respectively (p-value of 0.001). The mean number of analgesic administration in the first 24 hours was 2.24 +/- 0.48 in Group A vs. 2.41 +/- 0.52 in Group B (p-value = 0.02) respectively. Conclusion: Our study shows that low intra-abdominal pressure results in reduced frequency of post-operative shoulder tip pain without any prolongation of duration of surgery.