RESUMO
Laparoscopic gynecologic surgery [LGS] is an advantageous procedure that widely replaced the traditional open laparotomy especially for dingnostic purposes. However, high-pressure pneumoperitoneum was accused for precipitating some intraoperative hemodynamic effects and postoperative shoulder-tip pain [STP]. The objectives of this study were to determine the influence of low-pressure pneumoperitoneum on the frequency and intensity of shoulder-tip pain and body hemodynamics in patients undergoing LGS. The study comprised 87 female patients divided into two study groups: Group I, comprised 49 female assigned to undergo LGS under high-pressure [13-15 mmHg] and 38 patients under low-pressure [7-9 mmHg] [Group II]. Intraoperative monitoring included measurement of heart rate [HR], systolic and diastolic blood pressure, and mean arterial blood pressure [MAP] was calculated. The frequency of postoperative STP was determined and its intensity was determined using visual analogue scale charts VAS]. There was a significant [P<0.05] increase in MAP in both groups at 5 min after Insufflation, but there was a significant decrease of MAP in Group II as compared to Group I [x2=7.716, P<0.05]. There was a significant reduction of both frequency [15.8% vs. 26.5%] and intensity of STP in low-pressure group compared to high-pressure group. This difference was especially significant 6, 12.24 hours postoperatively. Moreover there was a positive significant correlation between the insufflated pressure and the frequency [r=0.691, P<0.05] and intensity [r=0.612, P<0.05] of STP. There was a significant reduction of the amount consumed of rescue analgesic [declphenac potassium 75 mg/cc, amp.] in low-pressure group compared to high-pressure group. We can conclude that reduction of the pressure of the pneumoperitoneum to 7-9 mmHg results in a significant reduction of both the frequency and intensity of shoulder-tip pain and allows more stable hemodynamics of the patients through the duration of LGS On the basis of these results, the widespread use of low-pressure pneumoperitoneum throughout most of a laparoscopic gynecologic procedure is recommended