Abstract:

Introduction: Laparoscopic pneumoperitoneum affect respiratory gas exchanges (PaCO2, EtCO2, pH and bicarbonate) leading to respiratory acidosis and hypercapnia that can amplify postoperative pain which mechanisms are multiple. Ventilator management may interfere with the inflammatory mechanism of pain.

Patients and methods: we conducted a prospective randomized trial including patients with physical status ASA I or II and proposed for laparoscopic cholecystectomy.

Thirty not premeditated patients aged more than 18 years, were randomized to be allocated to:

·         Group VC: classic ventilation 8cc/Kg of ideal body weight (IBW), PEP=5, I/E=1/2

·         Group VP: protective ventilation 6cc/Kg of IBW, PEP=8, I/E=1/2, and hyperventilation at closure time.

 Anesthesiologists in charged with post-operative evaluation are blinded to the patient’s allocation.

The primary outcome was the quality of postoperative analgesia. VAS was measured at H0, H2, H6, H12 and H24. The secondary outcome was enhanced post-operative recovery.

Results: We found that protective ventilation associated with hyperventilation at the end of laparoscopic surgery can significantly reduce postoperative pain, and morphine consumption leading to an enhanced post-operative recovery.

Conclusion: Protective ventilation associated with end surgery hyperventilation may reduce post-operative pain and allow an enhanced recovery. However, a larger sample size is needed to have more representative results. Dosage of   inflammation’s mediators should be considered