Gas Removal Techniques for Postoperative Pain
What You Need to Know Before You Apply
What is the purpose of this trial?
Laparoscopic surgery has revolutionized surgical care by reducing morbidity and improving post operative recovery. Laparoscopic surgery involves the use of carbon dioxide for insufflation to achieve optimal visualization. There is literature that demonstrates higher insufflation pressures being associated with increased postoperative pain - particularly shoulder pain - and opioid use1-3. The ideal amount of intraperitoneal pressure is still under debate as other studies demonstrate that reduced pneumoperitoneum insufflation has also shown to negatively impact surgeon satisfaction and trended with longer operative time and greater blood loss without impacting pain4.
Residual intraperitoneal carbon dioxide can also contribute to postoperative discomfort. Studies have shown the effectiveness of various maneuvers in removing residual gas to reduce postoperative pain, such as intraperitoneal saline instillation5, pulmonary recruitment6,7, and gas aspiration via smoke evauator8.
Despite these advantages, there is a lack of a clear consensus on the optimal method for reducing residual intraperitoneal gas. Conversely, literature has mixed results regarding the true significance in pain reduction3,5,9.
Given the importance of minimizing postoperative pain, reducing opioid requirements, and shortening postoperative recovery time, we propose a prospective, patient-blinded, randomized controlled trial. We aim to investigate whether active gas removal via a smoke evacuator, multiple breath recruitment maneuvers, or no intervention would contribute to lowest postoperative pain. We hope our findings will help identify the most effective method for reducing residual pneumoperitoneum-related pain and thus inform surgical practices and improve patient outcomes.
Are You a Good Fit for This Trial?
This trial is for adults aged 18 to 65 who are having planned (elective), non-cancerous laparoscopic surgery. People outside this age range or those not having benign procedures cannot participate.Inclusion Criteria
Exclusion Criteria
Timeline for a Trial Participant
Screening
Participants are screened for eligibility to participate in the trial
Treatment
Participants undergo laparoscopic surgery with different interventions for gas removal: smoke evacuation, recruitment breath, or no intervention
Follow-up
Participants are monitored for postoperative pain and opioid use
What Are the Treatments Tested in This Trial?
Interventions
- Active Gas Removal via Smoke Evacuator
- Multiple Breath Recruitment Maneuvers
Trial Overview
The study compares three approaches at the end of laparoscopic surgery: removing leftover gas with a smoke evacuator, using special breathing maneuvers, or doing nothing extra. Patients are randomly assigned to one of these groups without knowing which they get.
How Is the Trial Designed?
3
Treatment groups
Experimental Treatment
Placebo Group
Active gas removal via smoke evacuator for 30 seconds at the end of case
Repeated pulmonary inflation maneuvers: 3 consecutive manual ventilations at maximum of 30 cm H2O at the end of case
Passive desolation of the pneumoperitoneum at the end of the laparoscopic surgery
Find a Clinic Near You
Who Is Running the Clinical Trial?
Henry Ford Health System
Lead Sponsor
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