{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T12:47:34Z","timestamp":1791982054148,"version":"4.4.0"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>\n                      Post-operative shoulder tip pain (STP) is an established side effect of laparoscopic cholecystectomy, primarily attributed to diaphragmatic irritation from residual carbon dioxide (CO\u2082) insufflation during surgery. The purpose of this trial was to evaluate the severity of STP and the day of discharge after surgery between patients undergoing laparoscopic cholecystectomy who had low-pressure (10 mmHg, CO\n                      <jats:sub>2<\/jats:sub>\n                      ) and standard-pressure (14 mmHg, CO\n                      <jats:sub>2<\/jats:sub>\n                      ) pneumoperitoneum.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods:<\/jats:title>\n                    <jats:p>\n                      In this single-centre, double-blind, randomised controlled experiment, 100 patients scheduled for laparoscopic cholecystectomy were randomly allocated to one of two groups of 50 patients each, receiving either standard-pressure or low-pressure pneumoperitoneum. The primary outcomes included post-operative STP scores measured using a validated 10-point numerical rating scale at 3, 6, 12, 24, 48 and 72 h postoperatively. The secondary outcome was duration of hospitalisation.\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05 was considered statistically significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Study participants comprised 69% of females with a mean age of 44.2 \u00b1 12.8 years. Despite observed demographic variations, there were no statistically significant differences in baseline characteristics between the groups (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &gt; 0.05 for all comparisons). The standard-pressure group had significantly higher mean pain scores than the low-pressure group at 3 h (2.3 \u00b1 2.4 vs. 0.9 \u00b1 1.3), 6 h (1.5 \u00b1 1.8 vs. 0.5 \u00b1 0.9), 12 h (1.0 \u00b1 1.4 vs. 0.4 \u00b1 0.8) and 24 h (0.4 \u00b1 0.8 vs. 0.1 \u00b1 0.5) after surgery, with\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.006, 0.007, 0.018 and 0.049, respectively. From the 2\n                      <jats:sup>nd<\/jats:sup>\n                      day onwards, pain scores became minimal and showed no significant difference between the groups (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.662). The mean hospital stay was 2.04 \u00b1 0.198 days versus 2.00 \u00b1 0.000 days (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.159), with no clinically meaningful difference.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This study provides Level 1 evidence that low-pressure pneumoperitoneum during laparoscopic cholecystectomy significantly reduces STP for the first 24 h postoperatively, though this effect does not persist beyond 48 h. Hospital length of stay remained equivalent between the groups, suggesting that early pain reduction alone does not translate to accelerated discharge. This suggests the need for larger, multicentre trials to validate these findings and assess the effect of low-pressure pneumoperitoneum on additional patient-reported outcomes and healthcare economics.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jmas.jmas_219_25","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T12:02:53Z","timestamp":1774008173000},"page":"389-396","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Optimising pneumoperitoneum pressure to minimise post-operative shoulder tip pain: A randomised controlled trial of 10 versus 14 mmHg CO2 in laparoscopic cholecystectomy"],"prefix":"10.4103","volume":"22","author":[{"given":"K. R. P.","family":"Viknesh","sequence":"first","affiliation":[{"name":"Institute of General Surgery, Madras Medical College, Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sailesh I. S.","family":"Kumar","sequence":"additional","affiliation":[{"name":"Institute of General Surgery, Madras Medical College, Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raja Vel","family":"Shantharam","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Sri Lalithambigai Medical College and Hospital, Dr. MGR Educational and Research Institute, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashfaq Sulaiman Arif Abdul","family":"Rahuman","sequence":"additional","affiliation":[{"name":"Institute of General Surgery, Madras Medical College, Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashok Nimmakanty","family":"Ramadas","sequence":"additional","affiliation":[{"name":"Institute of General Surgery, Madras Medical College, Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peranbu","family":"Loganathan","sequence":"additional","affiliation":[{"name":"Institute of General Surgery, Madras Medical College, Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,3,19]]},"reference":[{"key":"R1-20261014","first-page":"e45704","article-title":"Laparoscopic cholecystectomy versus open cholecystectomy in acute cholecystitis: A literature review","volume":"15","author":"Mannam","year":"2023","journal-title":"Cureus"},{"key":"R2-20261014","doi-asserted-by":"crossref","first-page":"51","DOI":"10.22159\/ijcpr.2024v16i4.5008","article-title":"A comparative study between open cholecystectomy versus laparoscopic cholecystectomy","volume":"16","author":"Harsana","year":"2024","journal-title":"Int J Curr Pharm Res"},{"key":"R3-20261014","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1016\/j.ijsu.2015.04.083","article-title":"Open versus laparoscopic cholecystectomy in acute cholecystitis. Systematic review and meta-analysis","volume":"18","author":"Coccolini","year":"2015","journal-title":"Int J Surg"},{"key":"R4-20261014","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1186\/s13063-020-4140-7","article-title":"Randomized trial comparing low-pressure versus standard-pressure pneumoperitoneum in laparoscopic colectomy: PAROS trial","volume":"21","author":"Celarier","year":"2020","journal-title":"Trials"},{"key":"R5-20261014","doi-asserted-by":"crossref","first-page":"406","DOI":"10.4293\/108680812X13427982377184","article-title":"Laparoscopic cholecystectomy and newer techniques of gallbladder removal","volume":"16","author":"Comitalo","year":"2012","journal-title":"JSLS"},{"key":"R6-20261014","doi-asserted-by":"crossref","first-page":"502","DOI":"10.31729\/jnma.8719","article-title":"Postoperative pain after laparoscopic cholecystectomy in a tertiary care center: A descriptive cross-sectional study","volume":"62","author":"Shrestha","year":"2024","journal-title":"J Nepal Med Assoc"},{"key":"R7-20261014","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1007\/s11916-024-01355-y","article-title":"Post-laparoscopic shoulder pain management: A narrative review","volume":"29","author":"Zhao","year":"2025","journal-title":"Curr Pain Headache Rep"},{"key":"R8-20261014","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1007\/s00423-025-03666-z","article-title":"Effect of controlled hyperventilation on post-laparoscopic cholecystectomy shoulder pain: A prospective randomized controlled trial","volume":"410","author":"Li","year":"2025","journal-title":"Langenbecks Arch Surg"},{"key":"R9-20261014","doi-asserted-by":"crossref","first-page":"3","DOI":"10.7602\/jmis.2020.23.1.3","article-title":"Postoperative shoulder pain after laparoscopic surgery","volume":"23","author":"Park","year":"2020","journal-title":"J Minim Invasive Surg"},{"key":"R10-20261014","doi-asserted-by":"crossref","first-page":"243","DOI":"10.4103\/ajprhc.ajprhc_67_23","article-title":"A randomized comparison between classical landmark-based and ultrasound-guided right superficial cervical plexus block in attenuating postlaparoscopic shoulder pain under subarachnoid anesthesia","volume":"15","author":"Saravanan","year":"2023","journal-title":"Asian J Pharm Res Health Care"},{"key":"R11-20261014","doi-asserted-by":"crossref","first-page":"13421","DOI":"10.1038\/s41598-021-92762-3","article-title":"The risk of shoulder pain after laparoscopic surgery for infertility is higher in thin patients","volume":"11","author":"Li","year":"2021","journal-title":"Sci Rep"},{"key":"R12-20261014","first-page":"e1325","article-title":"The impact of intraoperative CO 2 pneumoperitoneum pressure in gastrointestinal surgery: A systematic review","volume":"35","author":"Mahapatra","year":"2025","journal-title":"Surg Laparosc Endosc Percutan Tech"},{"key":"R13-20261014","doi-asserted-by":"crossref","first-page":"3679","DOI":"10.18203\/2349-2902.isj20174885","article-title":"Intraoperative safety of low pressure pneumoperitoneum cholecystectomy: A comparative study","volume":"4","author":"Mahajan","year":"2017","journal-title":"Int Surg J"},{"key":"R14-20261014","doi-asserted-by":"crossref","first-page":"183","DOI":"10.4103\/jmas.jmas_78_24","article-title":"Impact of low-pressure pneumoperitoneum and deep neuromuscular blockade on surgeon satisfaction and patient outcomes in laparoscopic cholecystectomy patients: A prospective randomised controlled study","volume":"21","author":"Ko\u00e7","year":"2025","journal-title":"J Minim Access Surg"},{"key":"R15-20261014","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1186\/s13104-023-06492-y","article-title":"Effect of low-pressure pneumoperitoneum on pain and inflammation in laparoscopic cholecystectomy: A randomized controlled clinical trial","volume":"16","author":"Rashdan","year":"2023","journal-title":"BMC Res Notes"},{"key":"R16-20261014","doi-asserted-by":"crossref","first-page":"1400","DOI":"10.1097\/JS9.0000000000000289","article-title":"Low intra-abdominal pressure in laparoscopic surgery: A systematic review and meta-analysis","volume":"109","author":"Reijnders-Boerboom","year":"2023","journal-title":"Int J Surg"},{"key":"R17-20261014","doi-asserted-by":"crossref","first-page":"e399824","DOI":"10.1590\/acb399824","article-title":"Comparison of the therapeutic effects of different pneumoperitoneum pressures on laparoscopic transabdominal preperitoneal hernia repair: A randomized controlled trail","volume":"39","author":"Yao","year":"2024","journal-title":"Acta Cir Bras"},{"key":"R18-20261014","doi-asserted-by":"crossref","first-page":"1240","DOI":"10.1111\/aas.13938","article-title":"Quality of recovery in patients under low- or standard-pressure pneumoperitoneum. A randomised controlled trial","volume":"65","author":"Moro","year":"2021","journal-title":"Acta Anaesthesiol Scand"},{"key":"R19-20261014","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1177\/003335490912400320","article-title":"OpenEpi: A web-based epidemiologic and statistical calculator for public health","volume":"124","author":"Sullivan","year":"2009","journal-title":"Public Health Rep"},{"key":"R21-20261014","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1007\/s00384-024-04679-8","article-title":"Comparison of low versus high (standard) intraabdominal pressure during laparoscopic colorectal surgery: Systematic review and meta-analysis","volume":"39","author":"Hamid","year":"2024","journal-title":"Int J Colorectal Dis"},{"key":"R23-20261014","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.amjsurg.2013.09.027","article-title":"Low-pressure versus standard-pressure pneumoperitoneum for laparoscopic cholecystectomy: A systematic review and meta-analysis","volume":"208","author":"Hua","year":"2014","journal-title":"Am J Surg"},{"key":"R24-20261014","doi-asserted-by":"crossref","first-page":"754","DOI":"10.4103\/njcp.njcp_802_23","article-title":"Low pressure versus standard pressure pneumoperitoneum in laparoscopic appendectomy: A randomized controlled trial","volume":"27","author":"Adenuga","year":"2024","journal-title":"Niger J Clin Pract"},{"key":"R25-20261014","doi-asserted-by":"crossref","first-page":"276","DOI":"10.4174\/astr.2021.100.5.276","article-title":"Comparing postoperative pain in various pressure pneumoperitoneum of laparoscopic cholecystectomy: A double-blind randomized controlled study","volume":"100","author":"Chang","year":"2021","journal-title":"Ann Surg Treat Res"},{"key":"R26-20261014","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1590\/s1677-5538.ibju.2016.0366","article-title":"Which intraperitoneal insufflation pressure should be used for less postoperative pain in transperitoneal laparoscopic urologic surgeries?","volume":"43","author":"Akkoc","year":"2017","journal-title":"Int Braz J Urol"},{"key":"R27-20261014","doi-asserted-by":"crossref","first-page":"goae052","DOI":"10.1093\/gastro\/goae052","article-title":"Low-pressure versus standard-pressure pneumoperitoneum in minimally invasive colorectal surgery: A systematic review, meta-analysis, and meta-regression analysis","volume":"12","author":"Dourado","year":"2024","journal-title":"Gastroenterol Rep (Oxf)"}],"container-title":["Journal of Minimal Access Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jmas.jmas_219_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T12:01:02Z","timestamp":1791979262000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jmas.jmas_219_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,19]]},"references-count":25,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/jmas.jmas_219_25","relation":{},"ISSN":["0972-9941","1998-3921"],"issn-type":[{"value":"0972-9941","type":"print"},{"value":"1998-3921","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,19]]},"assertion":[{"value":"2025-06-03","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-14","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}