Impact of standard-pressure and low-pressure pneumoperitoneum on shoulder pain following laparoscopic cholecystectomy: a randomised controlled trial Hemanga K. Bhattacharjee 1 • Azarudeen Jalaludeen 1 • Virinder Bansal 1 • Asuri Krishna 1 • Subodh Kumar 1 • Rajeshwari Subramanium 2 • Rashmi Ramachandran 2 • Mahesh Misra 1 Received: 16 March 2016 / Accepted: 9 July 2016 Ó Springer Science+Business Media New York 2016 Abstract Background The incidence of shoulder pain (SP) follow- ing laparoscopic cholecystectomy (LC) varies between 21 and 80 %. A few randomised controlled trials and meta- analysis have shown lesser SP in LC performed under low- pressure carbon dioxide pneumoperitoneum (LPCP) than under standard-pressure carbon dioxide pneumoperitoneum (SPCP). However, the possible compromise in adequate exposure and effective working space during LPCP has negatively influenced its uniform adoption for LC. Materials and methods All consecutive patients undergo- ing elective LC for gallstone disease who met the inclusion and exclusion criteria were enroled. Fourty patients were randomised to SPCP group (pressure of 14 mmHg) and 40 to LPCP group (pressure of 9–10 mmHg). Primary out- come measured was incidence of SP and its severity on visual analogue scale (VAS) at 4, 8, 24 h and 7 days after LC. Secondary outcomes measured were procedural time, technical difficulty, surgeons’ satisfaction score on expo- sure and working space, intra-operative changes in heart rate and blood pressure, abdominal pain and analgesic requirement. Analyses were performed using Stata software. Results There was no conversion to open surgery, bile duct injury or need to increase intra-abdominal pressure on either group. Twenty-three patients (57.5 %) in SPCP group and nine patients (22.5 %) in LPCP group had SP (p = 0.001). The severity of SP was significantly more in SPCP group at 8 and 24 h (p = 0.009 and 0.005, respec- tively). Both the groups had similar procedural time, sur- geons’ satisfaction score, intra-operative changes in heart rate and blood pressure. Conclusion The incidence and severity of SP following LC performed at LPCP are significantly less compared to that in SPCP. The safety, efficacy and surgeons’ satisfaction appear to be comparable in both the groups. Hence, a routine practice of low-pressure carbon dioxide pneu- moperitoneum may be recommended in selected group of patients undergoing laparoscopic cholecystectomy. Clinical trial registration number CTRI/2016/02/006590. Keywords Laparoscopic cholecystectomy Á Shoulder pain Á Low-pressure pneumoperitoneum Á Standard- pressure pneumoperitoneum Á Surgeons’ satisfaction Presented at the SAGES 2016 Annual Meeting, March 16–19, 2016, Boston, Massachusetts. & Virinder Bansal drvkbansal@gmail.com Hemanga K. Bhattacharjee dr_hkb75@yahoo.com Azarudeen Jalaludeen azrudn@gmail.com Asuri Krishna dr.asurikrishna@gmail.com Subodh Kumar subodh6@gmail.com Rajeshwari Subramanium drsrajeshwari@gmail.com Rashmi Ramachandran rashmiramachandran1@gmail.com Mahesh Misra mcmisra@gmail.com 1 Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India 2 Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India 123 Surg Endosc DOI 10.1007/s00464-016-5108-2 and Other Interventional Techniques