title: A prospective randomized trial of postoperative pain following different insufflation pressures during gynecologic laparoscopy.
abstract: OBJECTIVE
  To determine the effects of different intra-abdominal pressure values on visceral pain following gynecologic laparoscopic surgery in the Trendelenburg position.
  
  
  METHODS
  This randomized, controlled prospective trial was conducted at a tertiary education hospital and included 150 patients who underwent gynecologic laparoscopy with different abdominal insufflation pressures. There were 54 patients in the 8 mmHg low pressure group (LPG), 45 in the 12 mmHg standard pressure group (SPG), and 51 in the 15 mmHg high pressure group (HPG). We assessed mean age, body mass index (BMI), duration of surgery, analgesic consumption, length of hospital stay, amount of CO2 expended and volume of hemorrhage. Visceral pain and referred visceral pain were assessed 6, 12, and 24 h postoperatively using a visual analog scale (VAS).
  
  
  RESULTS
  There was no significant difference in age, BMI, analgesic consumption or length of hospital stay among groups. The mean operative time and total CO2 expended during surgery were higher in the LPG compared with the SPG and HPG. The mean intensity of postoperative pain assessed by the VAS score at 6 and 12 h was less in the LPG than in the SPG and HPG and was reduced significantly at 12 h. VAS scores at 24 h in the LPG and SPG were lower than in the HPG.
  
  
  CONCLUSIONS
  Pain is reduced by low insufflation pressure compared with standard and high insufflation pressure following gynecologic laparoscopic surgery in the Trendelenburg position. However, low insufflation pressure may result in longer operation times and increased hemorrhage.
authors.affiliation: Zekai Tahir Burak Women Health Education and Research Hospital, Ankara, Turkey. Electronic address: dronurtopcu@gmail.com.
authors.forename: H O
authors.initials: HO
authors.lastname: Topçu
authors.affiliation: Zekai Tahir Burak Women Health Education and Research Hospital, Ankara, Turkey. Electronic address: sabri.cavkaytar@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Cavkaytar
authors.affiliation: Zekai Tahir Burak Women Health Education and Research Hospital, Ankara, Turkey. Electronic address: kuntaykokanali@gmail.com.
authors.forename: K
authors.initials: K
authors.lastname: Kokanalı
authors.affiliation: Zekai Tahir Burak Women Health Education and Research Hospital, Ankara, Turkey. Electronic address: alijnk@hotmail.com.
authors.forename: A I
authors.initials: AI
authors.lastname: Guzel
authors.affiliation: Balıkesir University, Department of Obstetrics and Gynecology, Balıkesir, Turkey. Electronic address: minetaskin1302@yahoo.com.tr.
authors.forename: M
authors.initials: M
authors.lastname: Islimye
authors.affiliation: Zekai Tahir Burak Women Health Education and Research Hospital, Ankara, Turkey. Electronic address: mdmirmart@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Doganay
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D002245:Carbon Dioxide; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D007327:Insufflation / Q000009:adverse effects* / Q000379:methods; D010535:Laparoscopy / Q000009:adverse effects*; D061646:Operative Time; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology*; D056888:Patient Positioning; D011312:Pressure / Q000009:adverse effects*; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D002245:Carbon Dioxide
keywords: Gynecologic laparoscopy; Intra-abdominal pressure; Pneumoperitoneum