Comparison of N2O and CO2 pneumoperitoneums during laparoscopic cholecystectomy with special reference to postoperative pain.
To study the possible benefits of N2O pneumoperitoneum, 40 patients scheduled for laparoscopic cholecystectomy for symptomatic cholelithiasis were randomized into either CO2-induced (n = 20) or N2O-induced (n = 20) pneumoperitoneum groups. The intensity of postoperative pain was assessed by the patients themselves using an visual analogue pain score scale. CO2 insufflation caused respiratory acidosis. The total amount of anesthetic enflurane needed was lower in the N2O than in the CO2 group (p < 0.041). The N2O group experienced less pain 1 hour (p < 0.040) and 6 hours (p < 0.017) postoperatively and the next morning. Serum cortisol and plasma adrenaline concentrations in the N2O group did not differ from those in the CO2 group. Patients with N2O pneumoperitoneum seem to have less pain without the side effects caused by CO2. The N2O pneumoperitoneum is a good alternative to the CO2 pneumoperitoneum, especially for prolonged laparoscopic operations in patients with chronic cardiopulmonary diseases.
Aitola
P
P
Department of Surgery, Tampere University Hospital and Medical School, University of Tampere, Finland.
Airo
I
I
Kaukinen
S
S
Ylitalo
P
P
D000142:Acidosis, Respiratory / Q000139:chemically induced; D000322:Adrenergic Agonists / Q000097:blood; D000328:Adult; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000704:Analysis of Variance; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D000893:Anti-Inflammatory Agents / Q000097:blood; D002245:Carbon Dioxide / Q000008:administration & dosage* / Q000009:adverse effects; D017081:Cholecystectomy, Laparoscopic; D002769:Cholelithiasis / Q000601:surgery; D004737:Enflurane / Q000008:administration & dosage; D004837:Epinephrine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D009609:Nitrous Oxide / Q000008:administration & dosage*; D010098:Oxycodone / Q000008:administration & dosage / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011028:Pneumoperitoneum, Artificial
D000322:Adrenergic Agonists; D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D018685:Anesthetics, Inhalation; D000893:Anti-Inflammatory Agents; D002245:Carbon Dioxide; D004737:Enflurane; D010098:Oxycodone; D009609:Nitrous Oxide; D006854:Hydrocortisone; D004837:Epinephrine