title: Minimizing shoulder pain following laparoscopic cholecystectomy: a prospective, randomized, controlled trial.
abstract: Abstract Background: Postoperative abdominal and shoulder pains after laparoscopic cholecystectomy (LC) are the most frequent complaints and are related to delayed recovery. There is a strong correlation between the residual gas volume and the severity of pain following various laparoscopic procedures. We aimed to investigate the effects of aspiration of residual gas on postoperative outcomes and pain following LC.
  
  
  METHODS
  Patients were randomly assigned to either the active gas reduction group (Group 1, n=105) or the control group (Group 2, n=95). After completion of the operative procedures, residual gas was aspirated with a flexible cannula in Group 1. In Group 2, gas release from the abdomen was performed using the port site by opening the gas tap only. The demographic data, operation time, insufflated CO2 volume during the operation, hospitalization period, and time to return to daily activities were recorded. Postoperative shoulder and abdominal pain assessment was performed using a numerical pain intensity scale (NPIS) at 1 hour, 24 hours, 3 days, and 7 days postoperatively.
  
  
  RESULTS
  There was no statistically significant difference between the groups in terms of demographic data, operative findings, and clinical outcomes. NPIS scores for shoulder pain at 1 hour and 24 hours were significantly lower in Group 1 (P=.001 and P=.021, respectively). However, there were no significant differences in the NPIS scores for shoulder and abdominal pain following 24 hours. No differences were found in the hospitalization duration and time to return to daily activities data (P>.05).
  
  
  CONCLUSIONS
  Active aspiration of the residual gas just before the removal of the trochars is a simple procedure and leads to a more comfortable hospital stay for patients.
authors.affiliation: Department of General Surgery, Numune Training and Research Hospital, Adana, Turkey. koraydas@yahoo.com
authors.forename: Koray
authors.initials: K
authors.lastname: Das
authors.forename: Faruk
authors.initials: F
authors.lastname: Karateke
authors.forename: Ebru
authors.initials: E
authors.lastname: Menekse
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ozdogan
authors.forename: Mehmet
authors.initials: M
authors.lastname: Aziret
authors.forename: Hasan
authors.initials: H
authors.lastname: Erdem
authors.forename: Suleyman
authors.initials: S
authors.lastname: Cetinkunar
authors.forename: Hatice
authors.initials: H
authors.lastname: Ozdogan
authors.forename: Selim
authors.initials: S
authors.lastname: Sozen
mesh_terms: D002245:Carbon Dioxide / Q000008:administration & dosage; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial; D011446:Prospective Studies; D020069:Shoulder Pain / Q000209:etiology* / Q000517:prevention & control*
chemical_list: D002245:Carbon Dioxide