Journal of Isfahan Medical School

Journal of Isfahan Medical School

Investigating the Effect of Two Doses of Acetazolamide, as a Precursor for Relief of Referral Pain, after Laparoscopic Cholecystectomy with Carbon Dioxide Gas, and Comparing it with Control Group

Document Type : Original Article (s)

Authors
Parvin Sajedi 1
Payman Soleimani 2
1 Professor, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Student of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
10.22122/jims.v36i482.9071
Abstract
Background: Referral pain is one of the most common complications after laparoscopic cholecystectomy. The aim of this study was to evaluate and compare the effect of different doses of acetazolamide on postoperative pain in patients undergoing laparoscopic cholecystectomy with carbon dioxide gas.Methods: In this double-blind clinical trial study, 90 patients who were candidates for laparoscopic cholecystectomy were enrolled and randomly divided into three groups. The first group was treated with acetazolamide (10 mg/kg up to 750 mg), the second group was treated with acetazolamide (5 mg/kg up to 375 mg), and the third group was treated with placebo (empty capsule) one hour before the operation. Then, the study variables were compared between three groups.Findings: At the baseline, and 6, 12, and 18 hours after the operation, referral pain was significantly less to more in first, second, and third groups, respectively (P < 0.050). Moreover, the need to analgesia (pethidine) in the first group was significantly lower than second and third groups (P < 0.001). However, the postoperative complications in the first group was significantly higher than others (P = 0.002).Conclusion: The usage of 10 mg/kg up to 750 mg of acetazolamide significantly reduced postoperative referral pain, and need to analgesia in patients undergoing laparoscopic cholecystectomy with carbon dioxide gas; but the complications of this dose were relatively higher, although were not severe.
Keywords
Acetazolamide
Cholecystectomy
Laparoscopy
Postoperative pain
Drug precursors
  1. Demco L. Effect of heating and humidifying gas on patients undergoing awake laparoscopy. J Am Assoc Gynecol Laparosc 2001; 8(2): 247-51.
  2. Minoli G, Terruzzi V, Spinzi GC, Benvenuti C, Rossini A. The influence of carbon dioxide and nitrous oxide on pain during laparoscopy: a double-blind, controlled trial. Gastrointest Endosc 1982; 28(3): 173-5.
  3. Corona R, Binda MM, Mailova K, Verguts J, Koninckx PR. Addition of nitrous oxide to the carbon dioxide pneumoperitoneum strongly decreases adhesion formation and the dose-dependent adhesiogenic effect of blood in a laparoscopic mouse model. Fertil Steril 2013; 100(6): 1777-83.
  4. Korell M, Schmaus F, Strowitzki T, Schneeweiss SG, Hepp H. Pain intensity following laparoscopy. Surg Laparosc Endosc 1996; 6(5): 375-9.
  5. Ren H, Tong Y, Ding XB, Wang X, Jin SQ, Niu XY, et al. Abdominal wall-lifting versus CO2 pneumoperitoneum in laparoscopy: A review and meta-analysis. Int J Clin Exp Med 2014; 7(6): 1558-68.
  6. Rettenmaier MA, Micha JP, Lopez KL, Wilcox AM, Goldstein BH. A prospective, observational trial assessing the efficacy of abdominal compression in reducing laparoscopic-induced shoulder pain. Surg Innov 2017; 24(6): 552-6.
  7. Koninckx PR, Corona R, Timmerman D, Verguts J, Adamyan L. Peritoneal full-conditioning reduces postoperative adhesions and pain: a randomised controlled trial in deep endometriosis surgery. J Ovarian Res 2013; 6(1): 90.
  8. Tsimoyiannis EC, Glantzounis G, Lekkas ET, Siakas P, Jabarin M, Tzourou H. Intraperitoneal normal saline and bupivacaine infusion for reduction of postoperative pain after laparoscopic cholecystectomy. Surg Laparosc Endosc 1998; 8(6): 416-20.
  9. Bala I, Bhatia N, Mishra P, Verma GR, Kaman L. Comparison of preoperative oral acetazolamide and intraperitoneal normal saline irrigation for reduction of postoperative pain after laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A 2015; 25(4): 285-90.
  10. Woehlck HJ, Otterson M, Yun H, Connolly LA, Eastwood D, Colpaert K. Acetazolamide reduces referred postoperative pain after laparoscopic surgery with carbon dioxide insufflation. Anesthesiology 2003; 99(4): 924-8.
  11. Movassaghi R, Peirovifar A, Aghamohammadi D, Mohammadipour AH, Golzari SE, Kourehpaz Z. Premedication with single dose of acetazolamide for the control of referral shoulder pain after laparoscopic cholecystectomy. Anesth Pain Med 2015; 5(6): e29366.
  12. Hanly EJ, Mendoza-Sagaon M, Murata K, Hardacre JM, De Maio A, Talamini MA. CO2 Pneumoperitoneum modifies the inflammatory response to sepsis. Ann Surg 2003; 237(3): 343-50.
  13. Singh R, Sen I, Wig J, Minz M, Sharma A, Bala I. An acetazolamide based multimodal analgesic approach versus conventional pain management in patients undergoing laparoscopic living donor nephrectomy. Indian J Anaesth 2009; 53(4): 434-41.
  14. Moazeni-Bistgani M, Mohammad Ali-Beigi F, Shahrjerdi S. Assessment of oral acetazolamide on postoperative pain after laparoscopic cholecystectomy. J Shahrekord Univ Med Sci. 2010; 12(2): 21-6. [In Persian].
  15. Pourladian I, Lois AW, Frelich MJ, Woehlck HJ, Weber M, Kastenmeier AS, et al. Acetazolamide reduces postoperative pain following laparoscopic inguinal herniorrhaphy. Surg Endosc 2016; 30(7): 2685-9.
Journal of Isfahan Medical School
Volume 36, Issue 482 - Serial Number 482
May and June 2018
Pages 621-628

  • Receive Date 27 October 2017
  • Accept Date 06 April 2022