Impact of Low-pressure versus Standard-pressure Pneumoperitoneum on Postoperative Shoulder-tip Pain in Laparoscopic Cholecystectomy: A Randomized Controlled Trial

Abstract Background: Postoperative shoulder-tip pain (STP) remains a common complication following laparoscopic cholecystectomy. It is primarily attributed to phrenic nerve irritation caused by carbon dioxide pneumoperitoneum. Aim: This study aimed to evaluate whether low-pressure pneumoperitoneum reduces postoperative STP without compromising surgical safety. Materials and Methods: A prospective, single-blind randomized controlled trial was conducted on 80 patients undergoing laparoscopic cholecystectomy. Patients were divided into low-pressure (8 mmHg) and standard-pressure (14 mmHg) groups. Pain scores, analgesic requirement, operative time, and surgeon satisfaction were assessed. Results: The low-pressure group demonstrated significantly lower STP scores at 12 h (2.1 ± 0.8 vs. 4.3 ± 1.2, P < 0.001) and reduced analgesic requirement (15% vs. 42.5%, P = 0.012). Operative time was slightly longer in the low-pressure group. Conclusion: Low-pressure pneumoperitoneum significantly reduces postoperative STP and analgesic requirements and is recommended for elective uncomplicated cases.