Şarer Ebru Akgün, Tahtaci Mustafa, Ersoy Umut Cahit, Honca Mehtap
Department of Anesthesiology, Bilkent City Hospital, Ankara, Turkiye.
Department of Gastroenterology, Bilkent City Hospital, Yıldırım Beyazıt University, Ankara, Turkiye.
Turk J Med Sci. 2025 Jan 15;55(1):277-286. doi: 10.55730/1300-0144.5969. eCollection 2025.
BACKGROUND/AIM: In gynecology, laparoscopic surgery has the advantages of reduced scarring, less postoperative pain, faster recovery, and lower risk of complications. Despite these advantages, shoulder pain still remains a major concern, affecting up to 90% of patients undergoing gynecologic laparoscopic surgery. Use of the abdominal compliance index (ACI) may offer the benefit of increased space for safer surgery and may prevent the drawback of high insufflation pressures. The aim of this study was to investigate the relationship between shoulder pain, abdominal pain, and analgesic use with the recently advised ACI, a surrogate index of abdominal expansion in patients undergoing gynecologic laparoscopic surgery.
Thirty-one patients with American Society of Anesthesiologists scores of 1-3 who underwent elective gynecologic laparoscopic surgery were included. The insufflation pressure was set to 12 mmHg. ACI, defined as insufflated intraabdominal volume (L) per body surface area (m), was used to estimate the relationship between abdominal compliance and postoperative pain.
The 31 patients were separated into two groups based on median ACI level (range 1.37-2.73 L/m), with those having values of 2.16 L/m or lower as group 1 and those with higher values as group 2. Abdominal visual analogue scale (VAS) scores at 30 min postoperative were significantly higher in group 2 than in group 1 (p < 0.001). Shoulder pain VAS scores at 24 h and 36 h postoperative were also significantly higher in group 2 than in group 1 (p = 0.021 and p = 0.002, respectively). The total amount of analgesic infusion and additional analgesic requirements were lower in group 1 than in group 2 (p = 0.049 and p = 0.001, respectively). ACI did not differ with patient demographic characteristics or history of abdominal/laparoscopic surgery, parity, abdominal drainage, and pneumoperitoneum time.
ACI, a surrogate index of abdominal expansion capacity, may be used to guide individualization of insufflation pressures by identifying female patients under risk of higher postoperative pain.
背景/目的：在妇科领域，腹腔镜手术具有瘢痕形成减少、术后疼痛减轻、恢复更快以及并发症风险更低等优点。尽管有这些优势，但肩部疼痛仍是一个主要问题，影响着高达90%的妇科腹腔镜手术患者。使用腹部顺应性指数（ACI）可能有助于增加手术空间以提高安全性，并可避免高气腹压力的弊端。本研究的目的是探讨在接受妇科腹腔镜手术的患者中，肩部疼痛、腹部疼痛及镇痛药物使用与最近建议使用的ACI（一种腹部扩张的替代指标）之间的关系。
纳入31例美国麻醉医师协会评分1 - 3分且接受择期妇科腹腔镜手术的患者。气腹压力设定为12 mmHg。ACI定义为每单位体表面积（m）的气腹内体积（L），用于评估腹部顺应性与术后疼痛之间的关系。
根据ACI中位数水平（范围1.37 - 2.73 L/m）将31例患者分为两组，ACI值为2.16 L/m或更低的为第1组，值更高的为第2组。术后30分钟时，第2组的腹部视觉模拟评分（VAS）显著高于第1组（p < 0.001）。术后24小时和36小时时，第2组的肩部疼痛VAS评分也显著高于第1组（分别为p = 0.021和p = 0.002）。第1组的镇痛药物输注总量和额外镇痛需求低于第2组（分别为p = 0.049和p = 0.001）。ACI与患者人口统计学特征、腹部/腹腔镜手术史、产次、腹腔引流及气腹时间无关。
ACI作为腹部扩张能力的替代指标，可通过识别术后疼痛风险较高的女性患者来指导气腹压力的个体化设置。
