Comparison of shoulder tip pain following low-pressure versus standard-pressure CO2 pneumoperitoneum in patients undergoing laparoscopic cholecystectomy at a tertiary care hospital

Background: Laparoscopic cholecystectomy (LC) is the standard treatment for symptomatic gallbladder disease. Low-pressure pneumoperitoneum (LPP) may improve post-operative recovery by reducing pain compared with standard pressure pneumoperitoneum. Aims and Objectives: This study aimed to compare post-operative outcomes, including shoulder tip pain, Visual Analog Scale (VAS) pain scores, analgesic requirement, and duration of hospital stay, following LC using low-pressure (8–10 mmHg) versus standard pressure (12–14 mmHg) CO2 pneumoperitoneum. Materials and Methods: This prospective randomized controlled study was conducted in the Department of General Surgery, Government Kilpauk Medical College and Hospital, Chennai, from November 2023 to April 2024. Eighty patients undergoing elective LC were randomized to low-pressure (8–10 mmHg) or standard-pressure (12–14 mmHg) pneumoperitoneum (40 patients per group). Post-operative shoulder tip pain was assessed using the VAS at 1, 6, 12, and 24 h. Analgesic requirement and duration of hospital stay were also evaluated. Results: Post-operative shoulder tip pain was significantly lower in the low-pressure group compared to the standard-pressure group (7 [17.5%] vs. 20 [50%]; P=0.002). Mean VAS scores were significantly lower in the low-pressure group at 1 h (0 vs. 0.325±0.474), 6 h (0.2±0.405 vs. 1.275±0.452), 12 h (0.2±0.405 vs. 1.001±0), and 24 h (0.075±0.266 vs. 0.375±0.490) (P<0.001). Analgesic requirement was lower in the low-pressure group (19 [47.5%] vs. 36 [90%]; P=0.001). Mean hospital stay was shorter in the low-pressure group (1.8±0.405 vs. 2.3±0.464 days; P<0.001). Conclusion: LPP in LC was associated with reduced post-operative pain, lower analgesic requirement, and shorter hospital stay, indicating improved post-operative recovery and patient comfort.