Warm and humidified insufflation gas during gynecologic laparoscopic surgery reduces postoperative pain in predisposed patients-a randomized, controlled multi-arm trial

被引:3
作者
Breuer, Markus [1 ]
Wittenborn, Julia [2 ]
Rossaint, Rolf [1 ]
Van Waesberghe, Julia [1 ]
Kowark, Ana [1 ]
Mathei, Deborah [2 ]
Keszei, Andras [3 ]
Tchaikovski, Svetlana [2 ]
Zeppernick, Magdalena [2 ,4 ]
Zeppernick, Felix [2 ,4 ]
Stickeler, Elmar [2 ]
Zoremba, Norbert [5 ]
Meinhold-Heerlein, Ivo [2 ,4 ]
Bruells, Christian [1 ]
机构
[1] Rhein Westfal TH Aachen, Univ Hosp, Dept Anesthesiol, Pauwelsstr 30, D-52074 Aachen, Germany
[2] Rhein Westfal TH Aachen, Univ Hosp, Dept Gynecol & Obstet, Pauwelsstr 30, D-52074 Aachen, Germany
[3] Rhein Westfal TH Aachen, Univ Hosp, Dept Med Stat, Pauwelsstr 30, D-52074 Aachen, Germany
[4] Justus Liebig Univ, Univ Hosp Giessen & Marburg, Dept Gynecol & Obstet, Klin Str 33, D-35392 Giessen, Germany
[5] St Elizabeth Hosp, Dept Anesthesiol & Intens Care, Stadtring Kattenstroth 130, D-33332 Gutersloh, Germany
来源
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES | 2022年 / 36卷 / 06期
关键词
Laparoscopy; Gynecology; Postoperative pain; Warm humidified insufflation gas; HEATED CARBON-DIOXIDE; EPIDURAL ANALGESIA; ADHESIONS; TEMPERATURE; HYPOTHERMIA; COLD; CO2;
D O I
10.1007/s00464-021-08742-1
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background Postoperative pain remains a common problem in gynecologic laparoscopy, especially in head zone-related regions, triggered by intra-abdominal pressure during capnoperitoneum. Humidified and prewarmed insufflation gas may ameliorate pain and be beneficial. Methods This prospective randomized controlled parallel group multi-arm single-center study investigated the effects of temperature and humidity of insufflation gas on postoperative pain during gynecologic laparoscopy with a duration >= 60 min. Female participants (18-70 years) were blinded and randomly assigned-computer generated-to either insufflation with dry cold CO2 with forced air warming blanket ("AIR"), humidified warm gas without forced air warming blanket ("HUMI"), or humidified warm gas with forced air warming blanket ("HUMI +"). We hypothesized that using humidified warm gas resulted in lower pain scores and less analgesic consumption. The primary endpoint postoperative pain was assessed for different pain localizations every 12 h during 7 days after surgery. Secondary endpoints were demand for painkillers and epidural anesthetics, length of stay in recovery room, and hospital stay. (Registration: ClinicalTrials.gov NCT02781194-completed). Results 150 participants were randomized. Compared to group "AIR" (n = 48), there was significantly less pain in group "HUMI +" (n = 48) in the recovery room (- 1.068; 95% CI - 2.08 to - 0.061), as well as significantly less ibuprofen use at day two (- 0.5871 g +/- 0.258; p-value = 0.0471). Other variables did not change significantly. Stratification for presence of endometriosis or non-previous abdominal surgery in patient history revealed significantly less pain in both groups "HUMI" (n = 50) and "HUMI +" versus group "AIR." Related side effects were not noted. Conclusion In the overall population, the use of warm, humidified insufflation gas did not yield clinically relevant effects; however, in predisposed patients with endometriosis and who could otherwise expect high pain levels, warm and humidified gas may be beneficial.
引用
收藏
页码:4154 / 4170
页数:17
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