Clinical Research Directory

Maneuvers to Reduce Laparoscopic Pain

Sponsor: Henry Ford Health System

Summary

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.

Official title: Optimal Maneuver to Reduce Postoperative Pain Following Elective Laparoscopic Surgeries

Key Details

Conditions

Interventions

Locations (1)