Publication:

Effect of routine abdominal drainage on postoperative pneumoperitoneum induced pain after elective laparoscopic cholecystectomy: a randomised controlled trial

Background Postoperative pain following laparoscopic cholecystectomy remains a clinical challenge despite the minimally invasive nature of the procedure. Residual pneumoperitoneum causes diaphragmatic irritation and phrenic nerve stimulation, causing referred shoulder pain affecting patient recovery. Various strategies have been proposed to address this problem, including routine abdominal drainage to facilitate carbon dioxide evacuation and sub - diaphragmatic instillation of local anesthetic agents. However, the comparative effectiveness of these two approaches remains inadequately investigated, with conflicting evidence in existing literature regarding their relative benefits.

Methods This prospective randomized comparative study was conducted over 18 months. 46 patients undergoing elective laparoscopic cholecystectomy were randomly allocated into two equal groups. The study group received sub hepatic abdominal drainage, while the control group received sub-diaphragmatic instillation of local anesthetic agent. Primary outcome was postoperative pain intensity assessed using Visual Analog Scale (VAS) at 3,6,9 and 12 hours post-surgery.

Results Both groups were comparable in demographic characteristics. VAS scores at 3,6 and 9 hours postoperatively showed no statistically significant differences between groups. However, at 12 hours post-surgery, the study group demonstrated significantly lower pain scores compared to the control group.

Conclusions Routine abdominal drainage demonstrates statistically significant superiority over sub-diaphragmatic local anesthetic instillation in reducing postoperative pain at 12 hours following elective laparoscopic cholecystectomy, though both interventions show comparable efficacy during the initial 0-9-hour period.