Intraperitoneal gas drain to reduce pain after laparoscopy: randomized masked trial

doi:10.1016/S0029-7844(01)01383-7

Obstetrics & Gynecology

Volume 98, Issue 1, July 2001, Pages 97-100

https://doi.org/10.1016/S0029-7844(01)01383-7 Get rights and content

Abstract

Objective:

To determine whether a drain placed in the peritoneal cavity during laparoscopy is both a clinical and cost-effective method of reducing postoperative pain.

Methods:

Two hundred twenty-five women undergoing diagnostic or minor operative laparoscopic procedures were recruited. Women were assigned to receive either an intraperitoneal gas drain or a dummy drain during surgery. Sample size to detect a two-point difference in visual analogue score was estimated at 158 subjects, with 79 in each arm. The patients and nursing staff were unaware of the position of the drain. A visual analogue score was used to assess pain preoperatively and at 4, 24, and 48 hours postoperatively. Data on the experience of nausea, frequency of vomiting, and site of pain were collected. The analgesic and antiemetic use was recorded. An economic evaluation of the analgesic use and the material costs for the two groups was performed.

Results:

One hundred sixty-one complete sets of data (72%) were available for analysis. The two groups were well matched for age, parity, previous surgery, body mass index, volume of carbon dioxide used, and operative time. No significant differences were found between the two groups with regard to the overall pain scores preoperatively (8 versus 7) or at 4 (30 versus 34), 24 (40 versus 44), and 48 (26 versus 26) hours postoperatively, after adjusting for multiple point testing. On assessment at different sites, the dummy drain group experienced shoulder pain more frequently at 4 (19 of 79 versus 10 of 82, P = .05) and 48 (16 of 79 versus 7 of 82, P = .03) hours postoperatively compared with the drain group. The placebo group had a 33% greater usage of oral analgesia after discharge, but this was $2.50 cheaper than the use of an intraperitoneal drain. No statistically significant differences were found between the groups with regard to nausea and vomiting postoperatively.

Conclusion:

An intraperitoneal drain after minor gynecologic laparoscopy decreases the frequency of shoulder pain and reduces postoperative analgesia requirements. However, it is less cost-effective to reduce pain using an intraperitoneal gas drain than simple oral analgesia after minor gynecologic laparoscopy.

Section snippets

Materials and methods

Approval for the study was obtained from the ethical committee. Two hundred twenty-five women were enrolled; complete data sets were available for 161. Women undergoing diagnostic laparoscopy, laparoscopic sterilization, laparoscopic hydrotubation, and minor laparoscopic procedures (minor adhesiolysis, excision, or ablation of stage I or II endometriosis, or aspiration of ovarian cysts) were eligible for this trial. Participants consented to the specific laparoscopic procedure and participation

Results

From the 225 patients entered into the study, 161 complete sets of data were available for analysis, 79 in the placebo group and 82 in the drain group. Of those excluded from the study, 14 (6%) were deemed unsuitable because more major surgery than planned was required, 32 (14%) had incomplete data sets, and 5 (2%) were randomized but no drain was placed. The response rate for the returned questionnaires was 82%, with 41 patients (18%) not returning their questionnaire. There may have been more

Discussion

Pain after laparoscopy is common, and the ability to decrease it further by simple, inexpensive measures would be advantageous. The site of pain is variable and is most commonly felt in the abdomen, shoulders, or back. Shoulder pain may occur in up to two thirds of patients,9, 10 although it is most commonly transient and by 24 hours has decreased, rarely lasting more than 72 hours.11, 12 Distension of the abdomen alone causes pain, and mechanical elevation of the abdominal wall is as painful

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In this retrospective cross-sectional study conducted in a tertiary referral medical center, women who underwent vNOTES between January 2018 and May 2019 were classified into control group and CPRM group with CO₂ force expelled. Data on the demographic characteristics, indications for surgery, and surgical history were collected. Postoperative pain was assessed 24 and 48 h postoperatively using the visual analog scale (VAS, 0–10). Chest radiography was used to determine the residual air volume 24 h after surgery.
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Citation Excerpt :
Three RCTs [16,19,20] reported no difference in pain scores at 4–6 h. Three RCTs [17,18,19] reported significantly lower pain scores at 46 h in the experimental group (p < .02, p < .05 and p < .02, respectively) compared to the control group. At 24 h, 3 RCTs [16,18,20] reported no difference in pain scores between the experimental and control groups, while 1 RCT [17] reported less pain in the experimental group (p < .05). At 48 h, 2 RCTs [16,20] reported similar pain scores in the experimental and control groups, while 1 RCT [18] found higher pain scores in the control group (p < .05).
We performed a systematic review of the randomized controlled trials (RCTs) reporting on the use of a peritoneal gas drain following gynecological laparoscopy. The standard medical databases were searched for studies published prior to with no restrictions for language, country of origin, blinding or sample size. We defined the primary endpoints: shoulder and total pain at 4–6, 24 and 48 h following laparoscopy and secondary endpoints: women satisfaction, requirement of analgesia and antiemetics. The quality of the included RCTs was assessed by the guideline of the Cochrane Collaboration. Based on the data from 5 moderate quality RCTs we concluded that there is very little evidence of an overall benefit from using a peritoneal gas drain following gynecological laparoscopy The possible reduction of shoulder and total pain is not associated with a reduction in the requirement of analgesia and antiemetics when compared to the control group.
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To drain or not to drain: the association between residual intraperitoneal gas and post-laparoscopic shoulder pain for laparoscopic cholecystectomy
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Original researchIntraperitoneal gas drain to reduce pain after laparoscopy: randomized masked trial

Abstract

Section snippets

Materials and methods

Results

Discussion

J Am Assoc Gynecol Laparosc

Obstet Gynecol

Br J Anaesth

J Am Assoc Gynecol Laparosc

Abdominal pain after laparoscopyThe value of a gas drain

Br J Obstet Gynaecol

A simple and effective way to reduce postoperative pain after laparoscopic cholecystectomy

Aust N Z J Surg

The effects of drains in laparoscopic cholecystectomy

J Laproendosc Surg

LaparoscopyGasless vs. CO2 pneumoperitoneum

J Reprod Med

Original research
Intraperitoneal gas drain to reduce pain after laparoscopy: randomized masked trial

LaparoscopyGasless vs. CO₂ pneumoperitoneum