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Turkish Journal of Medical Sciences

Abstract

Background/aimLaparoscopic surgery in gynecology has advantages of reduced scarring, less postoperative pain, faster recovery and lower risk of complications. Despite these adavantages, shoulder pain still remains a major concern affecting upto 90% of patients undergoing gynecologic laparoscopic surgery. The use of Abdominal compliance index (ACI) may offer the benefits of gaining work space for safer surgery and may prevent the drawbacks of applying higher insuflation pressures.We investigated the relation of shoulder pain and abdominal pain and analgesic use with the recently advised ACI which is a surrogate index of abdominal expansion in patients undergoing gynecologic laparoscopic surgery.Materials and methodsThirty one ASA1-3 patients who underwent elective gynecologic laparoscopic surgery were included. Insufflation pressure was set to 12 mmHg. ACI defined as Insufflated intraabdominal volume(L) perbody surface area(m2), was used to estimate the relation between abdominal compliance and postoperative pain.ResultsA total of 31 patients were included. The patients were seperated into 2 groups, according to median ACI level 2.16 L/m2(1.37-2.73) lower ACI patients as Group 1 and higher ACI patients as Group2. Postoperative abdominal VAS scores at 30th minute were significantly higher in Group2, when compared to Group1 (p<0.001). Postoperative shoulder pain VAS scores at 24th and 36th hour were significantly higher in Group2 than Group1 (p=0.021; p=0.002; respectively). The total amount of analgesic infusion and additional analgesic requirements were lower in Group1 compared to Group2 (p=0.049, p=0.001respectively) ACI did not differ with demographic characteristics of patients and history of abdominal/laparoscopic surgery, parity, abdominal drainage, and pneumoperitoneum time.ConclusionACI, a surrogate index of abdominal expansion capacity, may be used to guide individualization of insufflation pressures by identifying patients under risk of higher postoperative pain in female patients.

Author ORCID Identifier

EBRU ŞARER: 0000-0003-0185-7973

MUSTAFA TAHTACI: 0000-0003-4046-3715

UMUT CAHİT ERSOY: 0000-0002-5878-8027

MEHTAP HONCA: 0000-0003-1779-249X

DOI

10.55730/1300-0144.5969

Keywords

compliance, Laparoscopy, pneumoperitoneum, shoulder pain

First Page

277

Last Page

286

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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