A randomized controlled trial assessing the effect of heated carbon dioxide for insufflation on pain and recovery after laparoscopic fundoplication.
BACKGROUND
Insufflation with heated gas for laparoscopy may reduce postoperative pain. This study assessed the effect of heated gas on outcome after fundoplication.


METHODS
A blinded, randomized trial compared the effect of heated or standard carbon dioxide (CO2) on core temperature, postoperative pain, analgesic requirement, and postoperative recovery. Pain scores were assessed with a 100 mm visual analog scale (VAS). Recovery was assessed with a patient diary and clinical follow-up assessment at 8 days and 1 month postoperatively.


RESULTS
For this study, 40 patients were randomized to heated CO2 (n = 19) and standard CO2 (control) (n = 21) groups. The heated CO2 group increased core body temperature from 35.9 degrees to 36.1 degrees C, (p = 0.008), whereas the control group maintained core temperature at 35.8 degrees C. The control group had lower analgesic requirements and pain scores, significant at 12 h (VAS: 20 vs 36 mm; p = 0.04). There was no difference between the groups in terms of late recovery. The heated CO2 group showed a significant correlation between operative duration and requirement for postoperative morphine (p = 0.01).


CONCLUSIONS
Heated gas provides no benefit for patients and may be associated with increased early pain. The elevation of core body temperature observed with heated CO2 is of little clinical significance.
Wills
V L
VL
St. George Upper Gastrointestinal Surgical Unit, Level 5, Suite 1, St. George Private Medical Centre, 1 South St, Kogarah, 2217, New South Wales, Australia.
Hunt
D R
DR
Armstrong
A
A
D000328:Adult; D000368:Aged; D002245:Carbon Dioxide; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000601:surgery*; D006358:Hot Temperature; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis*; D011028:Pneumoperitoneum, Artificial / Q000379:methods*; D011336:Probability; D012016:Reference Values; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D002245:Carbon Dioxide