1
|
Okam PC, Ikechebelu JI, Eleje GU, Albert IC, Okpala BC, Okam CF, Nwajiaku LA, Joe-Ikechebelu NN, Ezeigwe CO, Chigbo CG, Okafor CG. Efficacy and safety of diclofenac suppository for postoperative pain relief after diagnostic hystero-laparoscopy and dye test: A double-blind, placebo-controlled, randomized trial. Eur J Obstet Gynecol Reprod Biol X 2024; 23:100326. [PMID: 39104867 PMCID: PMC11298888 DOI: 10.1016/j.eurox.2024.100326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 04/22/2024] [Accepted: 07/10/2024] [Indexed: 08/07/2024] Open
Abstract
Objective To determine the efficacy and safety of rectal diclofenac for relieving postoperative pain following diagnostic hystero-laparoscopy and dye test (dHLD). Methods A prospective, double-blind, placebo-controlled, randomized trial was conducted among women who underwent dHLD to evaluate fertility. The women received either rectal diclofenac with intramuscular pentazocine or intramuscular pentazocine with rectal placebo for postoperative analgesia. The median pain scores at different time points were assessed as the primary outcome measures using the Numerical Rating Scale for pain. The secondary outcome measures were analgesic consumption, time at which first analgesic was requested, satisfaction with pain relief and any adverse events. Results In total, 108 participants were analysed (54 in each group, 1:1 ratio). The median score for postoperative pain was lower for the diclofenac group compared with the placebo group at 4 h (52.53 vs 56.47; p = 0.507), 6 h (50.48 vs 58.52; p = 0.174), 8 h (51.42 vs 57.65; p = 0.296), 10 h (51.35 vs 57.65; p = 0.285) and 12 h (52.45 vs 56.55; p = 0.485) post surgery, although the difference was not significant (p > 0.05). Seventeen participants required rescue analgesia with 30 mg of pentazocine: 11 at 4 h post surgery [5 (62.5 %) vs 6 (66.7 %)], three at 6 h post surgery [2 (25.0 %) vs 1 (11.1 %)], two at 8 h post surgery [1 (12.5 %) vs 1 (11.1 %)], and one at 12 h post surgery [0 vs 1 (11.1 %)] for the diclofenac and placebo groups respectively (p = 0.713). There were no significant differences in postoperative adverse effect profiles, overall patient satisfaction, and need for rescue analgesia between the two groups (p > 0.05). Conclusions Postoperative use of rectal diclofenac and pentazocine is safe, but did not significantly improve pain scores, patient satisfaction and need for rescue analgesia following dHLD, compared with patients who received pentazocine and placebo. While a multi-modal approach to pain relief following dHLD does not appear to be significantly beneficial, a multi-centre study is needed to confirm or refute these findings.
Collapse
Affiliation(s)
- Princeston C. Okam
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
- Life Specialist Hospital Nnewi and Life International Hospital, Awka, Anambra State, Nigeria
- Department of Pharmacology and Therapeutics, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Joseph I. Ikechebelu
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
- Life Specialist Hospital Nnewi and Life International Hospital, Awka, Anambra State, Nigeria
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - George U. Eleje
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Innocent C. Albert
- Life Specialist Hospital Nnewi and Life International Hospital, Awka, Anambra State, Nigeria
| | - Boniface C. Okpala
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
- Life Specialist Hospital Nnewi and Life International Hospital, Awka, Anambra State, Nigeria
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Chioma F. Okam
- Department of Paediatrics, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Louis A. Nwajiaku
- Life Specialist Hospital Nnewi and Life International Hospital, Awka, Anambra State, Nigeria
| | - Ngozi N. Joe-Ikechebelu
- Life Specialist Hospital Nnewi and Life International Hospital, Awka, Anambra State, Nigeria
- Department of Community Medicine and Primary Heath Care, Faculty of Medicine, Chukwuemeka Odumegwu University, Awka, Anambra State, Nigeria
| | - Chijioke O. Ezeigwe
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Chisom G. Chigbo
- Institute of Public Health, University of Port-Harcourt, Rivers State, Nigeria
| | - Chigozie G. Okafor
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| |
Collapse
|
2
|
Serrano AB, Díaz-Cambronero Ó, Montiel M, Molina J, Núñez M, Mendía E, Mané MN, Lisa E, Martínez-Botas J, Gómez-Coronado D, Gaetano A, Casarejos MJ, Gómez A, Sanjuanbenito A. Impact of Standard Versus Low Pneumoperitoneum Pressure on Peritoneal Environment in Laparoscopic Cholecystectomy. Randomized Clinical Trial. Surg Laparosc Endosc Percutan Tech 2024; 34:1-8. [PMID: 37963307 DOI: 10.1097/sle.0000000000001244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 10/05/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND High CO 2 pneumoperitoneum pressure during laparoscopy adversely affects the peritoneal environment. This study hypothesized that low pneumoperitoneum pressure may be linked to less peritoneal damage and possibly to better clinical outcomes. MATERIALS AND METHODS One hundred patients undergoing scheduled laparoscopic cholecystectomy were randomized 1:1 to low or to standard pneumoperitoneum pressure. Peritoneal biopsies were performed at baseline time and 1 hour after peritoneum insufflation in all patients. The primary outcome was peritoneal remodeling biomarkers and apoptotic index. Secondary outcomes included biomarker differences at the studied times and some clinical variables such as length of hospital stay, and quality and safety issues related to the procedure. RESULTS Peritoneal IL6 after 1 hour of surgery was significantly higher in the standard than in the low-pressure group (4.26±1.34 vs. 3.24±1.21; P =0.001). On the contrary, levels of connective tissue growth factor and plasminogen activator inhibitor-I were higher in the low-pressure group (0.89±0.61 vs. 0.61±0.84; P =0.025, and 0.74±0.89 vs. 0.24±1.15; P =0.028, respectively). Regarding apoptotic index, similar levels were found in both groups and were 44.0±10.9 and 42.5±17.8 in low and standard pressure groups, respectively. None of the secondary outcomes showed differences between the 2 groups. CONCLUSIONS Peritoneal inflammation after laparoscopic cholecystectomy is higher when surgery is performed under standard pressure. Adhesion formation seems to be less in this group. The majority of patients undergoing surgery under low pressure were operated under optimal workspace conditions, regardless of the surgeon's expertise.
Collapse
Affiliation(s)
| | - Óscar Díaz-Cambronero
- Department of Anesthesiology, Perioperative Medicine Research Group, Hospital Universitari i Politécnic La Fe, Valencia, Spain
- EuroPeriscope: The ESA-IC Onco-Anaesthesiology Research Group
| | | | | | | | | | | | | | | | | | - Andrea Gaetano
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid
| | | | | | | |
Collapse
|
3
|
Rustia GM, Baracy MG, Khair E, Hagglund KH, Aslam MF. Pain With Differing Insufflation Pressures During Robotic Sacrocolpopexy: A Randomized Controlled Trial. Obstet Gynecol 2023; 142:151-159. [PMID: 37348093 DOI: 10.1097/aog.0000000000005231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 03/02/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE To evaluate whether decreasing insufflation pressure reduces postoperative pain and opioid use in women undergoing robotic-assisted sacrocolpopexy. METHODS In a single-blinded randomized trial, women with pelvic organ prolapse underwent robotic-assisted sacrocolpopexy at either 12 mm Hg (experimental) or 15 mm Hg (standard) insufflation pressure. The primary outcome was pain rating on a visual analog scale (VAS) on postoperative day 1 within 24 hours of surgery. Secondary outcomes included VAS pain rating at outpatient follow-up, inpatient and outpatient use of opioids, operative time, and estimated blood loss. A margin of 15 mm was considered clinically different on the VAS, and at 80% power, a sample size of at least 64 participants was needed to show significance. RESULTS From April 27, 2021, to May 17, 2022, 80 women were enrolled, with 41 in the experimental group and 39 in the standard group. All participants underwent surgery as planned and attended a 2-week postoperative follow-up. Participants in the experimental group had less pain on postoperative day 1 with median VAS of 17.0 mm (interquartile range 26.0) compared with 29.0 mm (interquartile range 32.0, P=.007) in the standard group. No differences were noted in the secondary outcomes of operative time, estimated blood loss, or length of stay. Participants in the experimental group were noted to use fewer opioids while an inpatient (P=.04) and outpatient (P=.02). In multivariable analyses, lower insufflation pressure and increasing age were negatively associated with postoperative VAS scores. CONCLUSION Lowering insufflation pressure (12 mm Hg) during robotic-assisted sacrocolpopexy safely reduced postoperative pain and opioid use compared with standard pressure (15 mm Hg). CLINICAL TRIAL REGISTRATION ClinialTrials.gov, NCT04858438.
Collapse
Affiliation(s)
- Gabriella M Rustia
- Department of Obstetrics and Gynecology, the Department of Biomedical Investigations and Research, and the Division of FPMRS, Department of Obstetrics and Gynecology, Ascension St. John Hospital, Detroit, and Michigan State University, East Lansing, Michigan
| | | | | | | | | |
Collapse
|
4
|
Reijnders-Boerboom GT, Albers KI, Jacobs LM, van Helden E, Rosman C, Díaz-Cambronero O, Mazzinari G, Scheffer GJ, Keijzer C, Warlé MC. Low intra-abdominal pressure in laparoscopic surgery: a systematic review and meta-analysis. Int J Surg 2023; 109:1400-1411. [PMID: 37026807 PMCID: PMC10389627 DOI: 10.1097/js9.0000000000000289] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 02/03/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Guidelines do not provide clear recommendations with regard to the use of low intra-abdominal pressure (IAP) during laparoscopic surgery. The aim of this meta-analysis is to assess the influence of low versus standard IAP during laparoscopic surgery on the key-outcomes in perioperative medicine as defined by the StEP-COMPAC consensus group. MATERIALS AND METHODS We searched the Cochrane Library, PubMed, and EMBASE for randomized controlled trials comparing low IAP (<10 mmHg) with standard IAP (10 mmHg or higher) during laparoscopic surgery without time, language, or blinding restrictions. According to the PRISMA guidelines, two review authors independently identified trials and extracted data. Risk ratio (RR), and mean difference (MD), with 95% CIs were calculated using random-effects models with RevMan5. Main outcomes were based on StEP-COMPAC recommendations, and included postoperative complications, postoperative pain, postoperative nausea and vomiting (PONV) scores, and length of hospital stay. RESULTS Eighty-five studies in a wide range of laparoscopic procedures (7349 patients) were included in this meta-analysis. The available evidence indicates that the use of low IAP (<10 mmHg) leads to a lower incidence of mild (Clavien-Dindo grade 1-2) postoperative complications (RR=0.68, 95% CI: 0.53-0.86), lower pain scores (MD=-0.68, 95% CI: -0.82 to 0.54) and PONV incidence (RR=0.67, 95% CI: 0.51-0.88), and a reduced length of hospital stay (MD=-0.29, 95% CI: -0.46 to 0.11). Low IAP did not increase the risk of intraoperative complications (RR=1.15, 95% CI: 0.77-1.73). CONCLUSIONS Given the established safety and the reduced incidence of mild postoperative complications, lower pain scores, reduced incidence of PONV, and shorter length of stay, the available evidence supports a moderate to strong recommendation (1a level of evidence) in favor of low IAP during laparoscopic surgery.
Collapse
Affiliation(s)
| | - Kim I. Albers
- Departments of Anesthesiology
- Surgery, Radboudumc, Nijmegen, The Netherlands
| | | | | | | | - Oscar Díaz-Cambronero
- Department of Anesthesiology, La Fé University and Polytechnic Hospital, Valencia, Spain
| | - Guido Mazzinari
- Department of Anesthesiology, La Fé University and Polytechnic Hospital, Valencia, Spain
| | | | | | | |
Collapse
|
5
|
Smith RB, Biller E, Hu C, Mahnert ND, Womack AS, Galhotra S, Mourad J. Impact of pneumoperitoneum pressure during laparoscopic hysterectomy: A randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2023; 280:73-77. [PMID: 36434823 DOI: 10.1016/j.ejogrb.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Minimally invasive hysterectomy is a commonly performed gynecologic procedure with associated postoperative pain managed with opioid medications. Uncontrolled postoperative pain leads to increased opioid use/abuse, longer hospital stays, increase in healthcare visits, and may negatively affect patient satisfaction. Current data suggests that reduced pneumoperitoneum insufflation pressure during laparoscopic surgery may impact postoperative pain. Given the current opioid epidemic, surgeons are proactively finding ways to reduce postoperative pain. It is unclear how reduced pneumoperitoneum pressure impacts the surgeon. We investigated the impact of reduced pneumoperitoneum insufflation pressure on surgeon satisfaction. STUDY DESIGN This was a pilot, double-blinded, randomized controlled trial from March 2020 to July 2021 comparing pneumoperitoneum pressure of 15 mmHg to reduced pressures of 12 mmHg and 10 mmHg during laparoscopic hysterectomy. RESULTS A total of 40 patients were randomized (13 - 15 mmHg, 13 - 12 mmHg, and 14 - 10 mmHg). The primary outcome was surgeon satisfaction. Secondary outcomes included patient satisfaction, operative time, blood loss, postoperative pain, opioid usage, and discharge timing. There were no differences in baseline demographics or perioperative characteristics. Surgeon satisfaction was negatively impacted with lower pneumoperitoneum pressures greatest with 10 mmHg, including overall satisfaction (p =.01), overall effect of the pneumoperitoneum (p =.04), and quality of visualization (p =.01). There was an apparent although not statistically significant difference in operative time (p =.06) and blood loss (p =.054). There was no difference in patient satisfaction, postoperative pain scores, opioid usage, or time to discharge. CONCLUSION(S) Reduced pneumoperitoneum insufflation pressure during laparoscopic hysterectomy negatively impacted surgeon satisfaction with a trend towards longer operative times and greater blood loss, and did not positively impact patient satisfaction, postoperative pain, opioid demand, or discharge timing.
Collapse
Affiliation(s)
- Rachael B Smith
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery University of Arizona College of Medicine - Phoenix, Banner University Medical Center - Phoenix, 1111 East McDowell Road, Phoenix, AZ 85006, USA.
| | - Emily Biller
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery University of Arizona College of Medicine - Phoenix, Banner University Medical Center - Phoenix, 1111 East McDowell Road, Phoenix, AZ 85006, USA
| | - Chengcheng Hu
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ 85724, USA
| | - Nichole D Mahnert
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery University of Arizona College of Medicine - Phoenix, Banner University Medical Center - Phoenix, 1111 East McDowell Road, Phoenix, AZ 85006, USA
| | - Ashley S Womack
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery University of Arizona College of Medicine - Phoenix, Banner University Medical Center - Phoenix, 1111 East McDowell Road, Phoenix, AZ 85006, USA
| | - Sheena Galhotra
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery University of Arizona College of Medicine - Phoenix, Banner University Medical Center - Phoenix, 1111 East McDowell Road, Phoenix, AZ 85006, USA
| | - Jamal Mourad
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery University of Arizona College of Medicine - Phoenix, Banner University Medical Center - Phoenix, 1111 East McDowell Road, Phoenix, AZ 85006, USA
| |
Collapse
|
6
|
AUGS-IUGA Joint Clinical Consensus Statement on Enhanced Recovery After Urogynecologic Surgery: Developed by the Joint Writing Group of the International Urogynecological Association and the American Urogynecologic Society. Individual writing group members are noted in the Acknowledgements section. UROGYNECOLOGY (HAGERSTOWN, MD.) 2022; 28:716-734. [PMID: 36288110 DOI: 10.1097/spv.0000000000001252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Enhanced recovery after surgery (ERAS) evidence-based protocols for perioperative care can lead to improvements in clinical outcomes and cost savings. This article aims to present consensus recommendations for the optimal perioperative management of patients undergoing urogynecological surgery. METHODS A review of meta-analyses, randomized clinical trials, large nonrandomized studies, and review articles was conducted via PubMed and other databases for ERAS and urogynecological surgery. ERAS protocol components were established, and then quality of the evidence was both graded and used to form consensus recommendations for each topic. These recommendations were developed and endorsed by the writing group, which is comprised of the American Urogynecologic Society and the International Urogynecological Association members. RESULTS All recommendations on ERAS protocol items are based on best available evidence. The level of evidence for each item is presented accordingly. The components of ERAS with a high level of evidence to support their use include fasting for 6 h and taking clear fluids up to 2 h preoperatively, euvolemia, normothermia, surgical site preparation, antibiotic and antithrombotic prophylaxis, strong antiemetics and dexamethasone to reduce postoperative nausea and vomiting, multimodal analgesia and restrictive use of opiates, use of chewing gum to reduce ileus, removal of catheter as soon as feasible after surgery and avoiding systematic use of drains/vaginal packs. CONCLUSIONS The evidence base and recommendations for a urogynecology-relevant ERAS perioperative care pathway are presented in this consensus review. There are several elements of ERAS with strong evidence of benefit in urogynecological surgery.
Collapse
|
7
|
AUGS-IUGA Joint clinical consensus statement on enhanced recovery after urogynecologic surgery. Int Urogynecol J 2022; 33:2921-2940. [DOI: 10.1007/s00192-022-05223-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/19/2022] [Indexed: 10/14/2022]
|
8
|
Claroni C, Morettini L, Tola G, Covotta M, Forastiere E, Torregiani G. Valveless Trocar Versus Standard Pneumoperitoneum Insufflation System in Minimally Invasive Surgery: Impact on Postoperative Pain. A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2022; 32:978-986. [PMID: 35404130 DOI: 10.1089/lap.2022.0022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The benefits of a valid pneumoperitoneum in laparoscopic surgery are counterbalanced by the possible negative effects of increased abdominal pressure and carbon dioxide (CO2) insufflation, which are crucial factors in causing postoperative pain. The purpose of this work is to evaluate the effectiveness of the valveless trocar (VT) insufflation system in decreasing postoperative pain and influencing operative time, compared to a standard insufflation system. Methods: A systematic research was performed using MEDLINE, EMBASE, Central Cochrane Library, and CINAHL Plus for studies published up to June 2020. Randomized controlled trials (RCTs) on adult population evaluating the effects of VT versus a standard insufflation system in laparoscopic surgery and reporting postoperative pain level and operative time were included in the analysis. Data and study quality indicators were extracted independently by 2 authors using a standardized form. Statistical analysis was based on a random effect model, using the inverse variance method. Results: We identified 3 RCTs for a total of 245 patients. The meta-analysis showed a statistically significant reduction in shoulder pain with the use of VT at 24 hours: mean difference (MD) -7.9% (95% confidence interval [95% CI]: -1.29 to 0.29; z = 3.08; P = .002) and a nonstatistically significant increase in operation time: MD 5.80 (95% CI: -8.93 to 20.54; P = .44). Conclusion: Our study suggests a better shoulder pain control at 24 hours postoperation using new-generation VT for laparoscopic surgery compared to standard insufflation system. Weak evidence of increased operating time with the VT was observed considering only two of the three RCTs. PROSPERO registration number: CRD42020191835.
Collapse
Affiliation(s)
- Claudia Claroni
- Department of Anesthesiology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Lucio Morettini
- Research Institute on Sustainable Economic Growth of the National Research Council of Italy, Rome, Italy
| | - Gabriele Tola
- Department of Anesthesiology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Marco Covotta
- Department of Anesthesiology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Ester Forastiere
- Department of Anesthesiology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Giulia Torregiani
- Department of Anesthesiology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| |
Collapse
|
9
|
Ebanga L, Dabi Y, Benichou J, Miailhe G, Kolanska K, Uzan J, Ferrier C, Bendifallah S, Haddad B, Darai E, Touboul C. Surgical Determinants of Post Operative Pain in Patients Undergoing Laparoscopic Adnexectomy. J INVEST SURG 2022; 35:1386-1391. [PMID: 35227151 DOI: 10.1080/08941939.2022.2045395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objective: The objective of our study was to determine the main surgical factors associated with postoperative pains in patients undergoing adnexectomy.Material and Methods: Patients that underwent adnexectomy in two French Gynecological centers between July, 2018 and March, 2020 were prospectively included and retrospectively analyzed. The main pre and per operative surgical factors were analyzed to assess their impact on immediate postoperative pain. Analgesic consumption was recorded for each patient and pain was evaluated using the validated numeric rating scale (ranging between 0 and 10).Results: One hundred and seventeen patients underwent laparoscopic adnexectomy. Eighty-four patients (72%) experienced either no or minor postoperative pain (NRS ≤ 2). Seventeen patients (14.5%) required strong opioids (subcutaneous morphine injection) in the immediate postoperative period. The only two parameters that had a significant impact on immediate postoperative pain were the realization of a fascia closure and the duration of pneumoperitoneum longer than 60 minutes. Pneumoperitoneum pressure and size of ports were not significantly correlated with postoperative pain.Conclusion: Fascia closure and increased surgical time were significantly associated with immediate postoperative pain and the need for strong opioids consumption. Surgical training to limit prolonged surgeries should be strongly emphasized to lower postoperative pain and limit opioids consumption.
Collapse
Affiliation(s)
- Lea Ebanga
- Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Yohann Dabi
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.,Sorbonne University, Paris, France
| | - Jeremie Benichou
- Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Gregoire Miailhe
- Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Kamila Kolanska
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.,Sorbonne University, Paris, France
| | - Jennifer Uzan
- Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Clement Ferrier
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.,Sorbonne University, Paris, France.,Groupe de recherche clinique 6 (GRC-6): Centre Expert En Endométriose (C3E), Assistance publique des hôpitaux de Paris, Tenon Hospital, Sorbonne University, Paris, France
| | - Bassam Haddad
- Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal de Créteil, Créteil, France.,Paris Est Créteil, University of Medecine, Créteil, France
| | - Emile Darai
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.,Sorbonne University, Paris, France.,Groupe de recherche clinique 6 (GRC-6): Centre Expert En Endométriose (C3E), Assistance publique des hôpitaux de Paris, Tenon Hospital, Sorbonne University, Paris, France
| | - Cyril Touboul
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.,Sorbonne University, Paris, France.,Groupe de recherche clinique 6 (GRC-6): Centre Expert En Endométriose (C3E), Assistance publique des hôpitaux de Paris, Tenon Hospital, Sorbonne University, Paris, France.,UMRS 938, Centre de recherche Saint Antoine, Sorbonne University, Paris, France
| |
Collapse
|
10
|
Analgesia for Gynecologic Oncologic Surgeries: A Narrative Review. Curr Pain Headache Rep 2022; 26:1-13. [PMID: 35118596 DOI: 10.1007/s11916-022-00998-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Gynecologic oncologic malignancies are amongst the most common cancers affecting women across the world. This narrative review focuses on the current state of evidence around optimal perioperative pain management of patients undergoing surgeries for gynecologic malignancies with a specific focus on cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). RECENT FINDINGS Recent improvements in postoperative pain management following all types of gynecologic procedures, including minimally invasive, open-abdominal, or CRS + HIPEC, have been implemented through enhanced recovery after surgery (ERAS) protocols. These protocols encompass the use of preemptive analgesia, neuraxial and regional techniques, local anesthetic infiltration, and multimodal analgesia. The severity of postoperative pain varies for minimally invasive cancer surgery to open debulking procedures. Therefore, an individualized perioperative analgesic plan is critical depending on the surgical approach. For CRS + HIPEC, neuraxial techniques such as thoracic epidurals and opioid sparing multimodal analgesics have shown efficacy in the perioperative period. However, future research is needed as many of these patients develop chronic pain with very limited research done in this realm.
Collapse
|
11
|
Kinoshita S, Kawaguchi C, Takagi T, Ohyama T. Proposal of a Novel Index of Abdominal Compliance and the Association With Postoperative Pain After Laparoscopic Inguinal Hernia Repair. Surg Laparosc Endosc Percutan Tech 2022; 32:182-187. [PMID: 35034069 DOI: 10.1097/sle.0000000000001033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 12/10/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND In laparoscopic surgery, low pneumoperitoneum pressure is reported to reduce pain, which suggests that easing abdominal expansion is crucial for less postoperative pain. However, although abdominal compliance (AC) is associated with the degree of abdominal expansion, the role of AC in pain by pneumoperitoneum is unknown. In this study, we devised a novel index as a surrogate of AC to evaluate the association between AC and postoperative pain in laparoscopic inguinal hernia repair. MATERIALS AND METHODS We reviewed 83 patients who underwent elective transabdominal preperitoneal repair from 2019 to 2021 at Heisei Memorial Hospital. Insufflation pressure was set to low pressure (8 mm Hg). The abdominal compliance index [ACI; insufflated intra-abdominal volume (L)/body surface area (m2)] was utilized to evaluate the association between AC and postoperative pain. RESULTS ACI was evaluated in 30 patients. Median ACI was 1.53 (1.00 to 2.48) L/m2. Although there was no difference in the average body constitution, the high ACI group (n=15) had significantly higher intra-abdominal volume at 8 mm Hg pressure, compared with the low ACI group (n=15) (3.1 vs. 2.1 L, P<0.0001). The high ACI group had significantly higher pain than the low ACI group on the day of surgery (2.0 vs. 1.0, P=0.006) and the day after (0.8 vs. 0.3, P=0.007). In addition, 46.7% of the patients in the high ACI group experienced pneumoperitoneum-associated pain, whereas patients in the low ACI group experienced incision pain only. Additional analgesics were administered in 53.3% of the high ACI group, compared with 33.3% in the low ACI group. CONCLUSIONS AC was suggested to be a vital factor of postoperative pain after laparoscopic inguinal hernia repair. Patients with high AC may be susceptible to higher pain by pneumoperitoneum, even in low-pressure settings.
Collapse
Affiliation(s)
- Shoichi Kinoshita
- Department of Surgery, Heisei Memorial Hospital, Kashihara, Nara Prefecture, Japan
| | | | | | | |
Collapse
|
12
|
Hamer J, Jones E, Chan A, Tahmasebi F. Can We Routinely Employ the Use of Low-Pressure Gynaecological Laparoscopy? A Systematic Review. Cureus 2021; 13:e15348. [PMID: 34235025 PMCID: PMC8244579 DOI: 10.7759/cureus.15348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 11/30/2022] Open
Abstract
Clinicians have learnt valuable lessons throughout the COV-SARS-2 pandemic, many of which have produced solutions that we aim to continue to implement within the foreseeable future. Optimising patients' surgical pathways to reduce the length of stay and complications is an area of particular importance, both for maximal utilisation of available resources and for reduction of the exposure of inpatient and elective patients to an increased risk of infection within healthcare facilities. The aim of this review was to investigate the possible implications of using low-pressure laparoscopic gynaecological surgery versus standard- or high-pressure pneumoperitoneum surgeries. The primary outcome was postoperative pain, with secondary outcomes including duration of surgery, length of inpatient stay and rate of complications. MEDLINE, Embase and Cochrane CENTRAL were searched from inception to December 2020. We searched for published randomised control trials comparing low-pressure laparoscopic surgery (≤8 mmHg) to at least one additional standardised pneumoperitoneum pressure (≥12 mmHg and/or ≥15 mmHg). A total of 203 studies were reviewed, five of which were included in this analysis. Studies comparing low-pressure laparoscopic surgery against gasless abdominal cavities were excluded. The meta-analysis of the results was pooled and calculated within RevMan 5.0 software (Cochrane, London, England). Studies using a visual analogue scale (1-10) to compare low versus standard pneumoperitoneum pressures did not display a significant diminution of postoperative pain at ≤ 6 or 24 hours: -0.30 [95% CI -0.63, 0.03] and -0.66 [95% CI -1.35, 0.02], respectively. Studies additionally demonstrated worse visualisation of the surgical field within the low-pressure group (risk ratio 10.31; 95% CI, 1.29-82.38 I2 = 0%). Studies measuring postoperative pain using a numerical rating scale displayed significant pain reduction at all hours measured (p ≤ 0.01). The rate of intraoperative complications was 1% for all groups measured. Cumulative analysis of the duration of surgery did not differ significantly between groups (p = 0.99). The pandemic has revealed new issues that must be addressed by clinicians to promote the safety of patients and the efficiency of inpatient stay. This review has paved the way for new possibilities and innovative approaches to address the issue of optimising patient surgical pathways; however, at present, we cannot give a firm justification for the use of low-pressure gynaecological laparoscopy. Reasons for this include the minimal reduction in pain scores between low, standard and high pneumoperitoneum pressures, leading to a mixture of statistically significant results, as well as a reduction in the visualisation of the surgical field and the small population sizes in the reviewed papers. Additional research is required to further explore the potential clinical benefits of gynaecological laparoscopy to ensure its effective ambulatory use within mainstream surgical operations.
Collapse
Affiliation(s)
- Jack Hamer
- Obstetrics and Gynaecology, Russells Hall Hospital, The Dudley Group National Health Service (NHS) Foundation Trust, Dudley, GBR
| | - Edward Jones
- Anaesthesiology, Russells Hall Hospital, The Dudley Group National Health Service (NHS) Foundation Trust, Dudley, GBR
| | - Amy Chan
- Obstetrics and Gynaecology, Russells Hall Hospital, The Dudley Group National Health Service (NHS) Foundation Trust, Dudley, GBR
| | - Farshad Tahmasebi
- Obstetrics and Gynaecology, Russells Hall Hospital, The Dudley Group National Health Service (NHS) Foundation Trust, Dudley, GBR
| |
Collapse
|
13
|
Foley CE, Ryan E, Huang JQ. Less is more: clinical impact of decreasing pneumoperitoneum pressures during robotic surgery. J Robot Surg 2020; 15:299-307. [PMID: 32572753 DOI: 10.1007/s11701-020-01104-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/09/2020] [Indexed: 01/01/2023]
Abstract
The objective of this study was to investigate the effects of decreasing insufflation pressure during robotic gynecologic surgery. The primary outcomes were patient-reported postoperative pain scores and length of stay. Secondary outcomes include surgical time, blood loss, and intraoperative respiratory parameters. This is a retrospective cohort study of patients undergoing robotic surgery for benign gynecologic conditions by a single minimally invasive surgeon at an academic hospital between 2014 and 2017. Patients were categorized by the maximum insufflation pressure reached during the surgery as either 15, 12, 10, or 8 mmHg. Continuous variables were compared using analysis of variance and χ2 test was used for categorical variables. 598 patients were included in this study with no differences in age, BMI, race, prior abdominal surgeries, or specimen weight between the four cohorts. When comparing cohorts, each decrease in insufflation pressure correlated with a significant decrease in initial pain scores (5.9 vs 5.4 vs 4.4 vs. 3.8, p ≤ 0.001), and hospital length of stay (449 vs 467 vs 351 vs. 317 min, p ≤ 0.001). There were no differences in duration of surgery (p = 0.31) or blood loss (p = 0.09). Lower operating pressures were correlated with significantly lower peak inspiratory pressures (p < 0.001) and tidal volumes (p < 0.001). Surgery performed at lower-pressure pneumoperitoneum (≤ 10 mmHg) is associated with lower postoperative pain scores, shorter length of stay, and improved intraoperative respiratory parameters without increased duration of surgery or blood loss. Operating at lower insufflation pressures is a low-cost, reversible intervention that should be implemented during robotic surgery as it results in the improved pain scores and shorter hospital stays.
Collapse
Affiliation(s)
- Christine E Foley
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA. .,Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. .,Magee-Womens Hospital, 300 Halket Street, Suite 2300, Pittsburgh, PA, 15213, USA.
| | - Erika Ryan
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA
| | - Jian Qun Huang
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA
| |
Collapse
|
14
|
Rosati M, Bramante S, Conti F, Frattari A, Rizzi M, Roman RA. Operative Gynecological Laparoscopy Under Conscious Sedation. JSLS 2020; 24:e2020.00020. [PMID: 32612345 PMCID: PMC7316526 DOI: 10.4293/jsls.2020.00020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Operative laparoscopy is generally performed under general anesthesia. Local anesthesia and conscious sedation may be useful in select short procedures. In the present study, we evaluated safety and efficacy of operative laparoscopy under conscious sedation. METHODS Retrospective observational study evaluating patients undergoing gynecologic laparoscopy. Laparoscopy under conscious sedation was performed for each patient with umbilical direct insertion of a 12-mm port, followed by 2 ancillary ports at 1 cm medially to the anterior superior iliac spine. Conversion to conventional laparoscopy or laparotomy was recorded. Conscious sedation was obtained using Remifentanil and Propofol, administered by an infusion system based on pharmacokinetic and pharmacodynamic models. Local anesthesia was administered at port insertion sites and for paracervical block. Pain intensity was evaluated with the Visual Analog Scale (VAS). Adverse events and drug concentrations throughout the procedure were retrieved. RESULTS Our study population included 166 patients. They underwent laparoscopic unilateral versus bilateral salpingo-oophorectomy, ovarian cystectomy, bilateral salpingo-oophorectomy and omentectomy for a borderline ovarian tumor, myomectomy; or underwent surgery for unexplained infertility evaluation, pelvic pain, staging of ovarian cancer. Mean duration of pneumoperitoneum was 22.3 ± 7.2 min. Rate of conversion to laparoscopy under general anesthesia was 17/166 (10.2%) and there were only 3 cases of patients with low tolerability to the procedure. No severe adverse events occurred. Hospital discharge occurred in all unconverted cases after 6 to 18 h. CONCLUSIONS Operative laparoscopy under conscious sedation and local anesthesia appears to be a feasible technique in gynecologic surgery with no adverse patient outcomes.
Collapse
Affiliation(s)
- Maurizio Rosati
- Unit of Obstetrics and Gynecology, Santo Spirito Hospital, Pescara, Italy
| | - Silvia Bramante
- Unit of Obstetrics and Gynecology, Santo Spirito Hospital, Pescara, Italy
| | - Fiorella Conti
- Unit of Obstetrics and Gynecology, Santo Spirito Hospital, Pescara, Italy
| | - Antonella Frattari
- Unit of Anaesthesia and Intensive Care, Santo Spirito Hospital, Pescara, Italy
| | - Maria Rizzi
- Unit of Anaesthesia and Intensive Care, Santo Spirito Hospital, Pescara, Italy
| | | |
Collapse
|
15
|
Bicket MC, Grant MC, Scott MJ, Terman GW, Wick EC, Wu CL. AAAPT Diagnostic Criteria for Acute Abdominal and Peritoneal Pain After Surgery. THE JOURNAL OF PAIN 2020; 21:1125-1137. [PMID: 32006701 DOI: 10.1016/j.jpain.2020.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 12/18/2019] [Accepted: 01/24/2020] [Indexed: 02/07/2023]
Abstract
Abdominal and peritoneal pain after surgery is common and burdensome, yet the lack of standardized diagnostic criteria for this type of acute pain impedes basic, translational, and clinical investigations. The collaborative effort among the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks, American Pain Society, and American Academy of Pain Medicine Pain Taxonomy (AAAPT) provides a systematic framework to classify acute painful conditions. Using this framework, a multidisciplinary working group reviewed the literature and developed core diagnostic criteria for acute abdominal and peritoneal pain after surgery. In this report, we apply the proposed AAAPT framework to 4 prototypical surgical procedures resulting in abdominal and peritoneal pain as examples: cesarean delivery, cholecystectomy, colorectal surgical procedures, and pancreas resection. These diagnostic criteria address the 3 most common surgical procedures performed in the United States, capture diverse surgical approaches, and may also be applied to other surgical procedures resulting in abdominal and peritoneal pain. Additional investigation regarding the validity and reliability of this framework will facilitate its adoption in research that advances our comprehension of mechanisms, deliver better treatments, and help prevent the transition of acute to chronic pain after surgery in the abdominal and peritoneal region. PERSPECTIVE: Using AAAPT, we present key diagnostic criteria for acute abdominal and peritoneal pain after surgery. We provide a systematic classification using 5 dimensions for abdominal and peritoneal pain that occurs after surgery, in addition to 4 specific surgical procedures: cesarean delivery, cholecystectomy, colorectal surgical procedures, and pancreas resection.
Collapse
Affiliation(s)
- Mark C Bicket
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Michael C Grant
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael J Scott
- Department of Anesthesiology, Virginia Commonwealth University; Richmond, Virginia
| | - Gregory W Terman
- Department of Anesthesiology, University of Washington, Seattle, Washington
| | - Elizabeth C Wick
- Department of Surgery; The University of California San Francisco, San Francisco, California
| | - Christopher L Wu
- Department of Anesthesiology, Critical Care & Pain Management; Hospital for Special Surgery, New York, New York; Department of Anesthesiology, Weill Cornell Medicine, New York, New York
| |
Collapse
|
16
|
Sao CH, Chan-Tiopianco M, Chung KC, Chen YJ, Horng HC, Lee WL, Wang PH. Pain after laparoscopic surgery: Focus on shoulder-tip pain after gynecological laparoscopic surgery. J Chin Med Assoc 2019; 82:819-826. [PMID: 31517775 DOI: 10.1097/jcma.0000000000000190] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Laparoscopy, one of minimally invasive procedures, is a commonly used procedure in diagnosis and management of various kinds of clinical problems, including gynecologic organ-related diseases. Compared with conventional exploratory laparotomy, the benefits of laparoscopic surgery include reduction of surgical wound, decreasing in postoperative pain, shortening hospital stay, rapid recovery, and a better cosmetic result. However, there are still up to 80% of patients after laparoscopic surgery complaining of high levels of pain and needing pain relief. Postlaparoscopic pain can be separated into distinct causes, such as surgical trauma- or incision wound-associated inflammatory change, and pneumoperitoneum (carbon dioxide [CO2])-related morphological and biochemical changes of peritoneum and diaphragm. The latter is secondary to irritation, stretching, and foreign body stimulation, leading to phrenic neuropraxia and subsequent shoulder-tip pain (STP). STP is the most typical unpleasant experience of patients after laparoscopic surgery. There are at least 11 strategies available to attempt to decrease postlaparoscopic STP, including (1) the use of an alternative insufflating gas in place of CO2, (2) the use of low-pressure pneumoperitoneum in place of standard-pressure pneumoperitoneum, (3) the use of warmed or warmed and humidified CO2, (4) gasless laparoscopy, (5) subdiaphragmatic intraperitoneal anesthesia, (6) local intraperitoneal anesthesia, (7) actively expelling out of gas, (8) intraperitoneal drainage, (9) fluid instillation, (10) pulmonary recruitment maneuvers, and (11) others and combination. The present article is limited in discussing postlaparoscopic STP. We extensively review published articles to provide a better strategy to reduce postlaparoscopic STP.
Collapse
Affiliation(s)
- Chih-Hsuan Sao
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | | | - Kai-Cheng Chung
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Jen Chen
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Huann-Cheng Horng
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Wen-Ling Lee
- Department of Medicine, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, ROC
- Female Cancer Foundation, Taipei, Taiwan, ROC
| |
Collapse
|
17
|
Radosa JC, Radosa MP, Schweitzer PA, Radosa CG, Stotz L, Hamza A, Takacs Z, Lepper PM, Wagenpfeil S, Linxweiler M, Morinello E, Solomayer EF. Impact of different intraoperative CO 2 pressure levels (8 and 15 mmHg) during laparoscopic hysterectomy performed due to benign uterine pathologies on postoperative pain and arterial pCO 2 : a prospective randomised controlled clinical trial. BJOG 2019; 126:1276-1285. [PMID: 31136069 DOI: 10.1111/1471-0528.15826] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the effects of two different intraoperative CO2 pressures (8 and 15 mmHg) during laparoscopic hysterectomy for benign uterine pathologies in terms of postoperative abdominal and shoulder pain, laparoscopy-mediated vegetative alterations, pain medication requirement, arterial CO2 pressure (pCO2 ), surgical parameters, and safety. DESIGN Prospective randomised controlled study. SETTING German university hospital. POPULATION Female patients undergoing laparoscopic hysterectomy for benign uterine pathologies. METHODS Patients were randomised to a standard pressure (SP; 15 mmHg, control) or low-pressure (LP; 8 mmHg, experimental) group. MAIN OUTCOME MEASURES Primary outcomes were postoperative abdominal and shoulder pain intensities, measured via numeric rating scale (NRS) and vegetative parameters (fatigue, nausea, vomiting, bloating) at 3, 24, and 48 hours postoperatively. Secondary outcomes were pain medication requirement (mg) and arterial pCO2 (mmHg). Surgical parameters and intra- and postoperative complications were also recorded. RESULTS In total, 178 patients were included. Patients in the LP group (n = 91) showed significantly lower postoperative abdominal and shoulder pain scores, fewer vegetative alterations, lower pain medication requirements, a shorter postoperative hospitalization, and lower intra- and postoperative arterial pCO2 values compared with the SP group (n = 87; P ≤ 0.01). No differences in intra- and postoperative complications were observed between groups. CONCLUSIONS Low-pressure laparoscopy seems to be an effective and safe technique for the reduction of postoperative pain and laparoscopy-induced metabolic and vegetative alterations following laparoscopic hysterectomy for benign indications. TWEETABLE ABSTRACT Low-pressure laparoscopy seems to be an effective and safe technique for reduction of pain following laparoscopic hysterectomy.
Collapse
Affiliation(s)
- J C Radosa
- Department of Obstetrics and Gynaecology, Saarland University Hospital, Homburg/Saar, Germany
| | - M P Radosa
- Department of Gynaecology, University Hospital of Leipzig, Leipzig, Germany
| | - P A Schweitzer
- Department of Obstetrics and Gynaecology, Saarland University Hospital, Homburg/Saar, Germany
| | - C G Radosa
- Department of Radiology, Dresden University Hospital, Dresden, Germany
| | - L Stotz
- Department of Obstetrics and Gynaecology, Saarland University Hospital, Homburg/Saar, Germany
| | - A Hamza
- Department of Obstetrics and Gynaecology, Saarland University Hospital, Homburg/Saar, Germany
| | - Z Takacs
- Department of Obstetrics and Gynaecology, Saarland University Hospital, Homburg/Saar, Germany
| | - P M Lepper
- Department of Internal Medicine, Pneumology, Allergology and Critical Care Medicine, Saarland University Hospital, Homburg/Saar, Germany
| | - S Wagenpfeil
- Institute of Medical Biometry, Epidemiology& Medical Informatics, Saarland University Hospital, Homburg/Saar, Germany
| | - M Linxweiler
- Department of Otorhinolaryngology and Head and Neck Surgery, Saarland University Hospital, Homburg/Saar, Germany
| | - E Morinello
- Department of Anaesthesiology, Saarland University Hospital, Homburg/Saar, Germany
| | - E-F Solomayer
- Department of Obstetrics and Gynaecology, Saarland University Hospital, Homburg/Saar, Germany
| |
Collapse
|
18
|
Moon S, Lim SH, Cho K, Kim MH, Lee W, Cho YH. The efficacy of vitamin C on postlaparoscopic shoulder pain: a double-blind randomized controlled trial. Anesth Pain Med (Seoul) 2019. [DOI: 10.17085/apm.2019.14.2.202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sungho Moon
- Departments of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Se Hun Lim
- Departments of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Kwangrae Cho
- Departments of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Myoung-hun Kim
- Departments of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Wonjin Lee
- Departments of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Yong Hyun Cho
- Departments of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| |
Collapse
|
19
|
Johansson VR, von Vogelsang A. Patient‐reported extremity symptoms after robot‐assisted laparoscopic cystectomy. J Clin Nurs 2019; 28:1708-1718. [DOI: 10.1111/jocn.14781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/28/2018] [Accepted: 12/18/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | - Ann‐Christin von Vogelsang
- Theme Neuro Karolinska University Hospital Stockholm Sweden
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
| |
Collapse
|
20
|
Kaloo P, Armstrong S, Kaloo C, Jordan V. Interventions to reduce shoulder pain following gynaecological laparoscopic procedures. Cochrane Database Syst Rev 2019; 1:CD011101. [PMID: 30699235 PMCID: PMC6353625 DOI: 10.1002/14651858.cd011101.pub2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Laparoscopy is a common procedure used to diagnose and treat various gynaecological conditions. Shoulder-tip pain (STP) as a result of the laparoscopy occurs in up to 80% of women, with potential for significant morbidity, delayed discharge and readmission. Interventions at the time of gynaecological laparoscopy have been developed in an attempt to reduce the incidence and severity of STP. OBJECTIVES To determine the effectiveness and safety of methods for reducing the incidence and severity of shoulder-tip pain (STP) following gynaecological laparoscopy. SEARCH METHODS We searched the following databases: Cochrane Gynaecology and Fertility (CGF) Specialised Register, the Cochrane Central Register of Studies Online (CRSO), MEDLINE, Embase, PsycINFO and CINAHL from inception to 8 August 2018. We also searched the reference lists of relevant articles and registers of ongoing trials. SELECTION CRITERIA Randomised controlled trials (RCTs) of interventions used during or immediately after gynaecological laparoscopy to reduce the incidence or severity of STP. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Primary outcomes: incidence or severity of STP and adverse events of the interventions; secondary outcomes: analgesia usage, delay in discharge, readmission rates, quality-of-life scores and healthcare costs. MAIN RESULTS We included 32 studies (3284 women). Laparoscopic procedures in these studies varied from diagnostic procedures to complex operations. The quality of the evidence ranged from very low to moderate. The main limitations were risk of bias, imprecision and inconsistency.Specific technique versus "standard" technique for releasing the pneumoperitoneumUse of a specific technique of releasing the pneumoperitoneum (pulmonary recruitment manoeuvre, extended assisted ventilation or actively aspirating intra-abdominal gas) reduced the severity of STP at 24 hours (standardised mean difference (SMD) -0.66, 95% confidence interval (CI) -0.82 to -0.50; 5 RCTs; 670 participants; I2 = 0%, low-quality evidence) and reduced analgesia usage (SMD -0.53, 95% CI -0.70 to -0.35; 4 RCTs; 570 participants; I2 = 91%, low-quality evidence). There appeared to be little or no difference in the incidence of STP at 24 hours (odds ratio (OR) 0.87, 95% CI 0.41 to 1.82; 1 RCT; 118 participants; low-quality evidence).No adverse events occurred in the only study assessing this outcome.Fluid instillation versus no fluid instillationFluid instillation is probably associated with a reduction in STP incidence (OR 0.38, 95% CI 0.22 to 0.66; 2 RCTs; 220 participants; I2 = 0%, moderate-quality evidence) and severity (mean difference (MD) (0 to 10 visual analogue scale (VAS) scale) -2.27, 95% CI -3.06 to -1.48; 2 RCTs; 220 participants; I2 = 29%, moderate-quality evidence) at 24 hours, and may reduce analgesia usage (MD -12.02, 95% CI -23.97 to -0.06; 2 RCTs; 205 participants, low-quality evidence).No study measured adverse events.Intraperitoneal drain versus no intraperitoneal drainUsing an intraperitoneal drain may reduce the incidence of STP at 24 hours (OR 0.30, 95% CI 0.20 to 0.46; 3 RCTs; 417 participants; I2 = 90%, low-quality evidence) and may reduce analgesia use within 48 hours post-operatively (SMD -1.84, 95% CI -2.14 to -1.54; 2 RCTs; 253 participants; I2 = 90%). We are uncertain whether it reduces the severity of STP at 24 hours, as the evidence was very low quality (MD (0 to 10 VAS scale) -1.85, 95% CI -2.15 to -1.55; 3 RCTs; 320 participants; I2 = 70%).No study measured adverse events.Subdiaphragmatic intraperitoneal local anaesthetic versus control (no fluid instillation, normal saline or Ringer's lactate)There is probably little or no difference between the groups in incidence of STP (OR 0.72, 95% CI 0.42 to 1.23; 4 RCTs; 336 participants; I2 = 0%; moderate-quality evidence) and there may be no difference in STP severity (MD -1.13, 95% CI -2.52 to 0.26; 1 RCT; 50 participants; low-quality evidence), both measured at 24 hours. However, the intervention may reduce post-operative analgesia use (SMD-0.57, 95% CI -0.94 to -0.21; 2 RCTs; 129 participants; I2 = 51%, low-quality evidence).No adverse events occurred in any study.Local anaesthetic into peritoneal cavity (not subdiaphragmatic) versus normal salineLocal anaesthetic into the peritoneal cavity may reduce the incidence of STP at 4 to 8 hours post-operatively (OR 0.23, 95% CI 0.06 to 0.93; 2 RCTs; 157 participants; I2 = 56%; low-quality evidence). Our other outcomes of interest were not assessed.Warmed, or warmed and humidified CO2 versus unwarmed and unhumidified CO2There may be no difference between these interventions in incidence of STP at 24 to 48 hours (OR 0.81 95% CI 0.45 to 1.49; 2 RCTs; 194 participants; I2 = 12%; low-quality evidence) or in analgesia usage within 48 hours (MD -4.97 mg morphine, 95% CI -11.25 to 1.31; 1 RCT; 95 participants; low-quality evidence); there is probably little or no difference in STP severity at 24 hours (MD (0 to 10 VAS scale) 0.11, 95% CI -0.75 to 0.97; 2 RCTs; 157 participants; I2 = 50%; moderate-quality evidence).No study measured adverse events.Gasless laparoscopy versus CO2 insufflationGasless laparoscopy may be associated with increased severity of STP within 72 hours post-operatively when compared with standard treatment (MD 3.8 (0 to 30 VAS scale), 95% CI 0.76 to 6.84; 1 RCT; 54 participants, low-quality evidence), and there may be no difference in the risk of adverse events (OR 2.56, 95% CI 0.25 to 26.28; 1 RCT; 54 participants; low-quality evidence).No study measured the incidence of STP. AUTHORS' CONCLUSIONS There is low to moderate-quality evidence that the following interventions are associated with a reduction in the incidence or severity, or both, of STP, or a reduction in analgesia requirements for women undergoing gynaecological laparoscopy: a specific technique for releasing the pneumoperitoneum; intraperitoneal fluid instillation; an intraperitoneal drain; and local anaesthetic applied to the peritoneal cavity (not subdiaphragmatic).There is low to moderate-quality evidence that subdiaphragmatic intraperitoneal local anaesthetic and warmed and humidified insufflating gas may not make a difference to the incidence or severity of STP.There is low-quality evidence that gasless laparoscopy may increase the severity of STP, compared with standard treatment.Few studies reported data on adverse events. Some potentially useful interventions have not been studied by RCTs of gynaecological laparoscopy.
Collapse
Affiliation(s)
- Philip Kaloo
- Gloucestershire Hospitals NHS Foundation TrustWomen's CentreGloucester Royal HospitalGloucesterUKGL1 3NN
| | - Sarah Armstrong
- University of SheffieldDepartment of Oncology & MetabolismAcademic Unit of Reproductive and Developmental MedicineLevel 4, The Jessop WingSheffieldUKS10 2SF
| | - Claire Kaloo
- Cheltenham General HospitalDepartment of AnaestheticsCheltenhamUKGL53 7AN
| | - Vanessa Jordan
- University of AucklandDepartment of Obstetrics and GynaecologyPrivate Bag 92019AucklandNew Zealand1003
| | | |
Collapse
|
21
|
De Robertis E, Caprino Miceli A, Colombo GL, Corcione A, Leykin Y, Scudeller L, Vizza E, Scollo P. Effects of Deep Versus Moderate Neuromuscular Blockade in Laparoscopic Gynecologic Surgery on Postoperative Pain and Surgical Conditions: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e131. [PMID: 29986847 PMCID: PMC6056743 DOI: 10.2196/resprot.9277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 02/28/2018] [Accepted: 02/28/2018] [Indexed: 11/24/2022] Open
Abstract
Background Postoperative pain, especially shoulder pain, is commonly reported after laparoscopic gynecologic procedures. Some studies suggest that a lower insufflation pressure may reduce the risk of postoperative pain; however, there is no agreement on the optimal pneumoperitoneum pressure during gynecologic laparoscopic surgery or whether lower pressure would lead to clinically significant improvements without increasing operative complications. Questions remain regarding the clinical significance of improvements, safety, and cost-effectiveness of deep neuromuscular blockade with low-pressure pneumoperitoneum. Objective The primary objective of this study was to assess the superiority of anesthesia with deep neuromuscular blockade with pneumoperitoneum 8 mm Hg over moderate blockade with pneumoperitoneum 12 mm Hg in terms of overall pain 24 hours after surgery in adult women undergoing pelvic surgery for hysterectomy or benign adnexal diseases. Effects on the intensity and timing of postoperative pain in specific locations, surgeon satisfaction, respiratory and hemodynamic stability, operating times, and direct and indirect costs will be assessed. Methods In this multicenter, randomized controlled trial with a superiority design, 300 patients will be randomly allocated in the ratio 1:1 to moderate neuromuscular blockade with a target insufflation pressure of 12 mm Hg or deep neuromuscular blockade with a target insufflation pressure of 8 mm Hg, with stratification by type of surgery and clinical center. The patient, the statistician, and the nurse who will assess the primary endpoint will be blinded to the allocation. Results Recruitment to this trial is expected to open in June 2018 and is expected to close in June 2019. Conclusions This study is designed to confirm the reported benefits of postoperative pain and provide additional data needed to address questions regarding the effects of this intervention on operating theater management and direct and indirect costs. Strengths of this protocol include the large sample size distributed among diverse institutions across the Italian territory and the collection and analysis of data on numerous secondary objectives. Limitations include the possible introduction of bias because the surgeon and anesthesiologist are not blinded to the intervention. Registered Report Identifier RR1-10.2196/9277
Collapse
Affiliation(s)
- Edoardo De Robertis
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Section of Anaesthesia and Intensive Care Medicine, University Federico II, Naples, Italy
| | | | - Giorgio L Colombo
- Department of Drug Sciences, School of Pharmacy, University of Pavia, Italy, Milan, Italy.,Studi Analisi Valutazioni Economiche, Milan, Italy
| | - Antonio Corcione
- Thoracic Surgery, AORN dei Colli Vincenzo Monaldi Hospital, Napoli, Italy
| | - Yigal Leykin
- Anesthesia and Intensive Care, Azienda per l'Assistenza Sanitaria n. 5 - Friuli Occidentale, Pordenone, Italy
| | - Luigia Scudeller
- Scientific Direction, Clinical Epidemiology Unit, IRCCS San Matteo Foundation, Pavia, Italy
| | - Enrico Vizza
- Gynecologic Oncology, Regina Elena Hospital, Rome, Italy
| | - Paolo Scollo
- Maternity and Early Childhood Department, Gynecology and Obstetrics, Cannizzaro Hospital, Catania, Italy
| | | | | |
Collapse
|
22
|
Cho S, Kim YJ, Jeong K, Moon HS. Ultrasound-guided bilateral rectus sheath block reduces early postoperative pain after laparoscopic gynecologic surgery: a randomized study. J Anesth 2018; 32:189-197. [DOI: 10.1007/s00540-018-2457-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 01/16/2018] [Indexed: 01/13/2023]
|
23
|
Wong M, Morris S, Wang K, Simpson K. Managing Postoperative Pain After Minimally Invasive Gynecologic Surgery in the Era of the Opioid Epidemic. J Minim Invasive Gynecol 2017; 25:1165-1178. [PMID: 28964926 DOI: 10.1016/j.jmig.2017.09.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 09/16/2017] [Accepted: 09/19/2017] [Indexed: 12/14/2022]
Abstract
In this review, we examine the evidence behind nonopioid medication alternatives, peripheral nerve blocks, surgical techniques, and postoperative recovery protocols that can help minimize and effectively treat postoperative pain after minimally invasive gynecologic surgery (MIGS). Because of the depth and heterogeneity of the data, a narrative review was performed of reported interventions. A comprehensive review was performed of PubMed, Embase, and the Cochrane Database with a focus on randomized controlled trials. In the absence of literature specific to benign gynecology, similar specialty or procedural data were reviewed. A variety of nonopioid medications, surgical techniques, and postoperative recovery protocols have shown significant improvements in postoperative pain after gynecologic surgery. Nonopioid medication options that are beneficial include acetaminophen, nonsteroidal anti-inflammatories, and antiepileptics. Incision infiltration with local anesthesia also significantly reduces pain. Surgically, minimally invasive approaches, reducing the laparoscopic trocar size to <10 mm, and evacuating the pneumoperitoneum at the end of the case all have significant benefits. Lastly, enhanced recovery pathways show promise in reducing pain after MIGS. By using a multimodal approach, minimally invasive gynecologic surgeons can help to minimize and manage postoperative pain with less reliance on opioid pain medications.
Collapse
Affiliation(s)
- Marron Wong
- Center for Minimally Invasive Gynecologic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts.
| | - Stephanie Morris
- Center for Minimally Invasive Gynecologic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Karen Wang
- Department of Minimally Invasive Gynecologic Surgery, Johns Hopkins Medical Center, Baltimore, Maryland
| | - Khara Simpson
- Department of Minimally Invasive Gynecologic Surgery, Johns Hopkins Medical Center, Baltimore, Maryland
| |
Collapse
|
24
|
Kundu S, Weiss C, Hertel H, Hillemanns P, Klapdor R, Soergel P. Association between intraabdominal pressure during gynaecologic laparoscopy and postoperative pain. Arch Gynecol Obstet 2017; 295:1191-1199. [PMID: 28285427 DOI: 10.1007/s00404-017-4325-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/07/2017] [Indexed: 01/08/2023]
Abstract
PURPOSE Laparoscopy is nowadays a well-established surgical method and plays a main role in an ever-increasing range of indications in gynaecology. High-quality studies of surgical techniques are necessary to improve the quality of patient care. The present study aims at evaluating postoperative pain after gynaecological laparoscopy depending on the intraoperative CO2 pressure. METHODS In a prospective, monocentric, randomized single-blind study at the Department of Gynaecology and Obstetrics at the Hannover Medical School, we include patients scheduled for different laparoscopic procedures. Randomization of the intraoperative CO2 pressure was carried out in six groups. Pain was assessed the day after surgery by the blinded nurse using a visual analogue scale. RESULTS 550 patients were included in the period from May 2013 to January 2016. The analysis of the per protocol population PPP (n = 360) showed no statistically significant difference between the six intervention groups with regard to mean postoperative pain perception. In direct comparison between two groups, an intraoperative CO2 pressure of 15 mmHg was associated with a significant higher pain score than a pressure of 12 mmHg. The difference was 7.46 mm on a 10 cm VAS. CONCLUSIONS The results of our study indicate that a CO2 pressure of 12 versus 15 mmHg can be advantageous. However, the clinical relevance remains unclear due to the low difference in pain. The additional benefit of an even lower pressure of 10 or 8 mmHg cannot be reliably assessed; we found signs of poor visibility conditions in these low pressure groups.
Collapse
Affiliation(s)
- Sudip Kundu
- Department of Obstetrics and Gynaecology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
| | - Clara Weiss
- Department of Obstetrics and Gynaecology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Hermann Hertel
- Department of Obstetrics and Gynaecology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Peter Hillemanns
- Department of Obstetrics and Gynaecology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Rüdiger Klapdor
- Department of Obstetrics and Gynaecology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Philipp Soergel
- Department of Obstetrics and Gynaecology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| |
Collapse
|
25
|
Akkoc A, Topaktas R, Aydin C, Altin S, Girgin R, Yagli OF, Sentürk AB, Metin A. Which intraperitoneal insufflation pressure should be used for less postoperative pain in transperitoneal laparoscopic urologic surgeries? Int Braz J Urol 2017; 43:518-524. [PMID: 28266816 PMCID: PMC5462144 DOI: 10.1590/s1677-5538.ibju.2016.0366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 09/20/2016] [Indexed: 11/26/2022] Open
Abstract
Purpose To determine whether using different intraperitoneal insufflation pressures for transperitoneal laparoscopic urologic surgeries decreases postoperative pain. Materials and Methods 76 patients who underwent transperitoneal laparoscopic upper urinary tract surgery at different insufflation pressures were allocated into the following groups: 10mmHg (group I, n=24), 12mmHg (group II, n=25) and 14mmHg (group III, n=27). These patients were compared according to age, gender, body mass index (BMI), type and duration of surgery, intraoperative bleeding volume, postoperative pain score and length of hospital stay. A visual analog scale (VAS) was used for postoperative pain. Results Demographic characteristics, mean age, gender, BMI and type of surgeries were statistically similar among the groups. The mean operation time was higher in group I than group II and group III but this was not statistically significant (P=0.810). The mean intraoperative bleeding volume was significantly higher in group I compared with group II and group III (P=0.030 and P=0.006). The mean length of postoperative hospital stays was statistically similar among the groups (P=0.849). The mean VAS score at 6h was significantly reduced in group I compared with group III (P=0.011). At 12h, the mean VAS score was significantly reduced in group I compared with group II and group III (P=0.009 and P<0.001). There was no significant difference in the mean VAS scores at 24h among three groups (P=0.920). Conclusion Lower insufflation pressures are associated with lower postoperative pain scores in the early postoperative period.
Collapse
Affiliation(s)
- Ali Akkoc
- Department of Urology, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Ramazan Topaktas
- Department of Urology, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Cemil Aydin
- Department of Urology, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Selcuk Altin
- Department of Urology, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Reha Girgin
- Department of Urology, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Omer Faruk Yagli
- Department of Urology, Kartal Yavuz Selim State Hospital, Istanbul, Turkey
| | - Aykut Bugra Sentürk
- Department of Urology, Hitit University, Training and Research Hospital, Corum, Turkey
| | - Ahmet Metin
- Department of Urology, Abant Izzet Baysal University Faculty of Medicine, Bolu, Turkey
| |
Collapse
|
26
|
Sroussi J, Elies A, Rigouzzo A, Louvet N, Mezzadri M, Fazel A, Benifla JL. Low pressure gynecological laparoscopy (7mmHg) with AirSeal ® System versus a standard insufflation (15mmHg): A pilot study in 60 patients. J Gynecol Obstet Hum Reprod 2017; 46:155-158. [PMID: 28403972 DOI: 10.1016/j.jogoh.2016.09.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 09/25/2016] [Accepted: 09/29/2016] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To evaluate feasibility of performing benign gynecologic pathology low pressure (7mmHg) laparoscopy (LPL) with AirSeal® system and to study benefits in terms of postoperative pain, when compared to a standard insufflation group (15mmHg). MATERIALS AND METHODS In this prospective randomized pilot study, 60 patients had laparoscopy for gynecologic benign pathology: 30 with 7mmHg and AirSeal system, and 30 with 15mmHg standard insufflator. The primary endpoint was incidence of shoulder pain. A postoperative questionnaire was completed by each patient to assess shoulder pain (Numeric Rating Scale [NRS], from 0 to 10) at H4, H8, H24, and consumption of morphinics was notified. During each procedure, anesthesia parameters were collected (peak airway pressure, systolic blood pressure, end tidal CO2). RESULTS Laparoscopy was performed on 30 patients in AirSeal®-LP group without need to increase pressure above 7mmHg, and no complication was reported. Incidence of shoulder pain was significantly lower in the AirSeal®-LP group (23.3% vs. 73.3%, P<0.001). NRS shoulder pain was significantly lower in AirSeal® LP group at hour 4, 8 and 24. Maximal values of ETCO2, systolic blood pressure, and peak airway pressure were significantly lower in AirSeal®-LP group. CONCLUSION LP (7mmHg) laparoscopy with AirSeal® platform allows laparoscopic surgery with less postoperative shoulder pain. These results could facilitate the development of ambulatory laparoscopy.
Collapse
Affiliation(s)
- J Sroussi
- Department of Gynecology and Obstetrics, Lariboisière Hospital, 2, rue Ambroise-Paré, 75010 Paris, France; Department of Gynecology and Obstetrics, Trousseau Hospital, 26, avenue du Dr-A.-Netter, 75012 Paris, France.
| | - A Elies
- Department of Gynecology and Obstetrics, Lariboisière Hospital, 2, rue Ambroise-Paré, 75010 Paris, France; Department of Gynecology and Obstetrics, Trousseau Hospital, 26, avenue du Dr-A.-Netter, 75012 Paris, France
| | - A Rigouzzo
- Department of Anesthesiology and Intensive Care, Trousseau Hospital, 26, avenue du Dr-A.-Netter, 75012 Paris, France
| | - N Louvet
- Department of Anesthesiology and Intensive Care, Trousseau Hospital, 26, avenue du Dr-A.-Netter, 75012 Paris, France
| | - M Mezzadri
- Department of Gynecology and Obstetrics, Lariboisière Hospital, 2, rue Ambroise-Paré, 75010 Paris, France; Department of Gynecology and Obstetrics, Trousseau Hospital, 26, avenue du Dr-A.-Netter, 75012 Paris, France
| | - A Fazel
- Department of Gynecology and Obstetrics, Lariboisière Hospital, 2, rue Ambroise-Paré, 75010 Paris, France
| | - J-L Benifla
- Department of Gynecology and Obstetrics, Lariboisière Hospital, 2, rue Ambroise-Paré, 75010 Paris, France; Department of Gynecology and Obstetrics, Trousseau Hospital, 26, avenue du Dr-A.-Netter, 75012 Paris, France
| |
Collapse
|
27
|
Rosati M, Bramante S, Conti F, Rizzi M, Frattari A, Spina T. Laparoscopic Salpingo-oophorectomy in Conscious Sedation. JSLS 2016; 19:JSLS.2015.00031. [PMID: 26175550 PMCID: PMC4487954 DOI: 10.4293/jsls.2015.00031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction: Conscious sedation has traditionally been used for laparoscopic tubal ligation. General anesthesia with endotracheal intubation may be associated with side effects, such as nausea, vomiting, cough, and dizziness, whereas sedation offers the advantage of having the patient awake and breathing spontaneously. Until now, only diagnostic laparoscopy and minor surgical procedures have been performed in patients under conscious sedation. Case Description: Our report describes 5 cases of laparoscopic salpingo-oophorectomy successfully performed with the aid of conventional-diameter multifunctional instruments in patients under local anesthesia. Totally intravenous sedation was provided by the continuous infusion of propofol and remifentanil, administered through a workstation that uses pharmacokinetic–pharmacodynamic models to titrate each drug, as well as monitoring tools for levels of conscious sedation and local anesthesia. We have labelled our current procedure with the acronym OLICS (Operative Laparoscopy in Conscious Sedation). Four of the patients had mono- or bilateral ovarian cysts and 1 patient, with the BRCA1 gene mutation and a family history of ovarian cancer, had normal ovaries. Insufflation time ranged from 19 to 25 minutes. All patients maintained spontaneous breathing throughout the surgical procedure, and no episodes of hypotension or bradycardia occurred. Optimal pain control was obtained in all cases. During the hospital stay, the patients did not need further analgesic drugs. All the women reported high or very high satisfaction and were discharged within 18 hours of the procedure. Discussion and Conclusion: Salpingo-oophorectomy in conscious sedation is safe and feasible and avoids the complications of general anesthesia. It can be offered to well-motivated patients without a history of pelvic surgery and low to normal body mass index.
Collapse
Affiliation(s)
| | | | | | - Maria Rizzi
- Anesthesia and Intensive Care, Santo Spirito Hospital, Pescara, Italy
| | | | - Tullio Spina
- Anesthesia and Intensive Care, Santo Spirito Hospital, Pescara, Italy
| |
Collapse
|
28
|
Kyle EB, Maheux-Lacroix S, Boutin A, Laberge PY, Lemyre M. Low vs Standard Pressures in Gynecologic Laparoscopy: a Systematic Review. JSLS 2016; 20:e2015.00113. [PMID: 26955258 PMCID: PMC4769697 DOI: 10.4293/jsls.2015.00113] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The optimal intraperitoneal pressure during laparoscopy is not known. Recent literature found benefits of using lower pressures, but the safety of doing abdominal surgery with low peritoneal pressures needs to be assessed. This systematic review compares low with standard pneumoperitoneum during gynecologic laparoscopy. DATABASE We searched Medline, Embase, and the Cochrane Library for randomized controlled trials comparing intraperitoneal pressures during gynecologic laparoscopy. Two authors reviewed references and extracted data from included trials. Risk ratios, mean differences, and standard mean differences were calculated and pooled using RevMan5. Of 2251 studies identified, three were included in the systematic review, for a total of 238 patients. We found a statistically significant but modest diminution in postoperative pain of 0.38 standardized unit based on an original 10-point scale (95% confidence interval [CI], -0.67 to -0.08) during the immediate postoperative period when using low intraperitoneal pressure of 8 mm Hg compared with ≥ 12 mm Hg and of 0.50 (95% CI, -0.80 to -0.21) 24 hours after the surgery. Lower pressures were associated with worse visualization of the surgical field (risk ratio, 10.31; 95% CI, 1.29-82.38). We found no difference between groups over blood loss, duration of surgery, hospital length of stay, or the need for increased pressure. CONCLUSION Low intraperitoneal pressures during gynecologic laparoscopy cannot be recommended on the behalf of this review because improvement in pain scores is minimal and visualization of the surgical field is affected. The safety of this intervention as well as cost-effectiveness considerations need to be further studied.
Collapse
Affiliation(s)
- Esther B Kyle
- CHU de Québec - Université Laval Research Center (CHUL), Québec, QC, Canada
| | | | - Amélie Boutin
- CHU de Québec - Université Laval Research Center (CHUL), Québec, QC, Canada
| | - Philippe Y Laberge
- CHU de Québec - Université Laval Research Center (CHUL), Québec, QC, Canada
| | - Madeleine Lemyre
- CHU de Québec - Université Laval Research Center (CHUL), Québec, QC, Canada
| |
Collapse
|
29
|
Bogani G, Martinelli F, Ditto A, Chiappa V, Lorusso D, Ghezzi F, Raspagliesi F. Pneumoperitoneum pressures during pelvic laparoscopic surgery: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2015; 195:1-6. [DOI: 10.1016/j.ejogrb.2015.09.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 06/22/2015] [Accepted: 09/23/2015] [Indexed: 01/12/2023]
|
30
|
Özdemir-van Brunschot DMD, van Laarhoven KCJHM, Scheffer GJ, Pouwels S, Wever KE, Warlé MC. What is the evidence for the use of low-pressure pneumoperitoneum? A systematic review. Surg Endosc 2015; 30:2049-65. [PMID: 26275545 PMCID: PMC4848341 DOI: 10.1007/s00464-015-4454-9] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 07/16/2015] [Indexed: 12/20/2022]
Abstract
Background Laparoscopic surgery has several advantages when compared to open surgery, including faster postoperative recovery and lower pain scores. However, for laparoscopy, a pneumoperitoneum is required to create workspace between the abdominal wall and intraabdominal organs. Increased intraabdominal pressure may also have negative implications on cardiovascular, pulmonary, and intraabdominal organ functionings. To overcome these negative consequences, several trials have been performed comparing low- versus standard-pressure pneumoperitoneum. Methods A systematic review of all randomized controlled clinical trials and observational studies comparing low- versus standard-pressure pneumoperitoneum. Results and conclusions Quality assessment showed that the overall quality of evidence was moderate to low. Postoperative pain scores were reduced by the use of low-pressure pneumoperitoneum. With appropriate perioperative measures, the use of low-pressure pneumoperitoneum does not seem to have clinical advantages as compared to standard pressure on cardiac and pulmonary function. Although there are indications that low-pressure pneumoperitoneum is associated with less liver and kidney injury when compared to standard-pressure pneumoperitoneum, this does not seem to have clinical implications for healthy individuals. The influence of low-pressure pneumoperitoneum on adhesion formation, anastomosis healing, tumor metastasis, intraocular and intracerebral pressure, and thromboembolic complications remains uncertain, as no human clinical trials have been performed. The influence of pressure on surgical conditions and safety has not been established to date. In conclusion, the most important benefit of low-pressure pneumoperitoneum is lower postoperative pain scores, supported by a moderate quality of evidence. However, the quality of surgical conditions and safety of the use of low-pressure pneumoperitoneum need to be established, as are the values and preferences of physicians and patients regarding the potential benefits and risks. Therefore, the recommendation to use low-pressure pneumoperitoneum during laparoscopy is weak, and more studies are required.
Collapse
Affiliation(s)
- Denise M D Özdemir-van Brunschot
- Division of Vascular and Transplant Surgery, Department of Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Kees C J H M van Laarhoven
- Division of Vascular and Transplant Surgery, Department of Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Gert-Jan Scheffer
- Department of Anesthesiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sjaak Pouwels
- Division of Vascular and Transplant Surgery, Department of Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Kim E Wever
- Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michiel C Warlé
- Division of Vascular and Transplant Surgery, Department of Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| |
Collapse
|