Correlation of Intra-Abdominal Co2 Pressure in Laparoscopic Cholecystectomy to Shoulder-Tip Pain

Muhammad Hamza Ali, Mamona Sadiq, Memoona Shahjahan


BACKGROUND KNOWLEDGE: Most of the time patients complain of pain at the tip of shoulder after undergoing Lap. Cholecystectomy. This study was conducted to find relation of low pressure pneumoperitoneum generated during lap. Cholecystectomy and reduced incidence of shoulder tip pain after operation.

Material and Methods: This is a prospective type study. It was done on 100 patients reported in surgical unit of Bahawal Victoria Hospital Bahawalpur from 1st February 2017 to 31st January 2018. They were divided into two groups. In group-A (60) those patients were kept in which low pressure pneumoperitoneum was generated with 12mmHg CO2 pressure and in group-B (40) those patients were included in which normal pressure pneumoperitoneum was generated with 16 mmHg CO2 pressure for laparoscopic cholecystectomy. Finding was recorded on pain scale 1, 4, 8, 12, 16, 24 and 48 hours of operation.

Results:  In low pressure peritoneum normal surgery was done without increase of duration and no complication was noticed. After operation 20() patients from group A and 9 patients from group B complained of shoulder tip pain. Its mean duration was 16 hours after operation. Pain was settled after using mild analgesia in both groups. No other complication occurred. High dose of analgesia was not required.

Conclusion: It is concluded that low pressure of CO2 used to generate pneumoperitoneum lowers the chances of shoulder tip pain after laparoscopic cholecystectomy and lowers the severity of pain as well.


Laparoscopy, cholecystectomy, pneumoperitoneum, CO2 pressure

Full Text:



Dobbs FF, Kumar V, Alexander JI, Hull MGR. Pain after laparoscopy related to posture and ring versus clip sterilization. Br. J. Obstet Gynaecol 1987; 94: 262-6.

Riedel HH, Semm K. Das postpeviskopische (laparoskopische) Schmerzsyndrom . Geburthilfe Frauenheil 1980; 40: 635-43.

Tsimoyiannis EC, Glantzounis G, Lekkas ET, Siakas P, Jabarin M, Tzouron H. Intraperitoneal normal saline and bupivacaine infusion for reduction of postoperative pain after laparoscopic cholecystectomy. Surg Laparosc Endosc 1998;8:416-20.

Cunniffe MG, McAnena OJ, Dar MA, Calleary J, Flynn NA. A prospective randomized trial of intra operative bupivacaine irrigation for management of should tip pain following laparoscopy. Am J. Surg 1998; 176: 258-61.

Dubois F, Icard P. Berthelot G, Levard H. Coelioscopic cholecystomy. Preliminary report of 36 cases. Ann Surg 1990; 211: 60-2.

Nyerges A. Pain mechanisms in laparoscopic surgery. Semin laparosc surg 1994; 1: 215-18.

Aitola P, Airo I, Kaukinen S, Ylitalo P. Comparison fo N2O and CO2 pneumoperitoneums during laparoscopic cholecystectomy with special reference to postoperative pain. Surg Laparosc Endosc 1998; 8: 140-4.

Wallace DH, Serpell MG, Baxter JN, O’Dwyer PJ. Randomized trial of different insufflation pressures for laparoscopic cholecystectomy. Br J Surg 1997; 84: 455-8.

Berberoglu M, Dilek ON, Ercan F, Kati I, Ozmen M. The efect of CO2 insufflation rate on the post laparoscopic shoulder pain. J Laparoendosc Adv Surg Tech A 1998; 8: 273-7.

Rosenblum M, Weller RS, Conard PL, Falvey EA, Gross JB. Jbuprofen provides longer lasting analgesia than fentanyl after laparoscopic surgery. Anesth Analg 1991; 73: 255-9.

Gillberg LE, Harsten AAS, Stahl LB. Preoperative diclofenac sodium reduces post laparoscopy pain. Can J Anaesth 1993; 40: 406-8.

Edwards ND, Barclay K, Catling SJ, Martin DG. Morgan RH. Day case laparoscopy; a survey of post operative pain and an assessment of the value of diclofenac. Anaesthesia 1991; 46: 1077-80.

Baram D, Smith C, Stinson S. Intraoperative topical etidocaine for reducing post operative pain after laparoscopic tubal ligation. J Reprod Med 1990; 35: 407-10.

Helvacioglu A, Weis R. Operative laparoscopy and post operative pain relief. Fertil Steril 1992; 57: 548-452.

Kelly MC. An assessment of the value of intraperitoneal bupivacaine for analgesia after laparoscopic sterilisation. Br J Obstet Gynaecol 1996; 103: 837-9.

Narchi P, Benhamou D, Fernandez H. Intraperitoneal local anaesthetic for shoulder pain after day case laparoscopy. Lancet 1991; 338: 1569-70.

Schulte Steinberg H, Weninger E, Jokisch D, Hofstetter B, Misera A, Lange V et al. Intraperitoneal versus interpleural morphine or bupivacane for pain after laparoscopic cholecystectomy. Anesthesiology 1995; 82: 634-40.

Scheinin B, Kellokumpu I, Lindgren L, Haglund C, Rosenberg PH. Effect of intraperitoneal bupivacaine on pain after laparoscopic cholecystectomy. Acta anaesthesiol Scand 1995; 39: 195-8.

Szem JW, Hydo L, Barie PS. A double blinded evaluation of intraperitoneal bupivacaine vs. saline for the reduction of post operative pain and nausea after laparoscopic cholecystectomy. Surg Endosc 1996; 10: 44-8.

Pasqualucci A, de Angelis V, Contardo R, Colo F, Terrosu G, Donini A et al. Preemptive analgesia : intra peritoneal local anaesthetic in laparoscopic cholecystectomy. A randomized, double blind placebo controlled study. Anesthesiology 1996;85:11-20.

Mraovic B, Jurisic T, Kogler Majeric V, sustic A. Intra peritoneal bupivacaine for analgesia after laparoscopic cholecystectomy. Acta anaesthesiol Scand 1997;41:193-6.

Korell M, Schmaus F, Strowitzki T, Schneeweiss SG. Hepp H. Pain intensity following laparoscopy: Surg Laparosc Endoc 1996; 6: 375-9.

Unbehaun N, Feussner H, Siewert JR. Niederdruckinsufflationstechnik in de r lap arskopischen cholezystektomie. Min Invas Chir 1995; 4: 10-15.


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.