Abstract

To investigate the postoperative pain intensity after laparoscopic gynecologic surgeries conducted with different pneumoperitoneal pressures. This study was designed as a single-blinded prospective randomized trial in a tertiary referral center. Patients who were scheduled to undergo laparoscopic surgery for benign gynecologic pathologies between dates August 2018 and December 2019 were included. Exclusion criterias were ; malign gynecologic diseases , lack of consent and conversion to laparotomy. Primary outcome measure was postoperative pain scores at 6th and 24th hour time point ; secondary outcome measures were shoulder tip pain and need for opioid type analgesic. The initial and intraoperative pressure for group 1 was 15 mm Hg, the initial pressure was 15 mm-Hg and intraoperative pressure was 12 mm Hg for group 2, and the initial and intraoperative pressure was 12 mm Hg for group 3. Visual analog score (VAS) surveys were performed in postoperative follow-ups for the 6th and 24th hours. The presence of shoulder tip pain and the postoperative opioid analgesic requirement was additionally evaluated. One hundred and seventy-one patients were investigated for per-protocol analysis. The mean 6th and 24th-hour VAS scores of the three study groups were 4.9;3.5; 5.0;4.1, and 5.3;4.3 respectively, for groups 1, 2, and 3 (p=0.506). The difference in shoulder tip pain rates was not statistically significant at each time point between the patient groups (p=0.829 and p=0.334, respectively). Opioid analgesic requirement was significantly higher in patients undergoing laparoscopic hysterectomy with 15 mm Hg intraabdominal pressure (p=0.004). Surgeons should take into account that high intraperitoneal pressures may cause more opioid analgesic requirement. Although pain scores and shoulder tip pain were comparable, opioid analgesic requirement is an important health issue.

Key words: laparoscopic CO2 pressure, postoperative pain score, postoperative opioid analgesic requirement, shoulder tip pain