A Novel Strategy of Laparoscopic Insufflation Rate Improving Shoulder Pain: Prospective Randomized Study

  • Kuo-Feng Hsu
  • Cheng-Jueng ChenEmail author
  • Jyh-Cherng Yu
  • Si-Yuan Wu
  • Bao-Chung Chen
  • Chih-Wei Yang
  • Teng-Wei Chen
  • Chung-Bao Hsieh
  • De-Chuan ChanEmail author
Original Article



Laparoscopic surgery is the main trend method in a variety of surgical fields. Post-operative shoulder pain remains a bothersome issue although many surgical techniques have been applied to minimize it. A simple novel approach to reduce shoulder pain without adverse effects during and after laparoscopic surgery is desired.


This prospective randomized controlled study was conducted to enroll a total of 140 patients to evaluate the efficacy of low flow rate (1 L/min) for induction followed by high flow rate (10 L/min) for maintaining 12 mmHg pneumoperitoneum (group A, n = 70) during laparoscopic cholecystectomy (LC), compared to the continuous high flow rate group (group B, n = 70) in postoperative shoulder pain and other clinical features. The 10-visual analog scale (VAS) was applied for the severity of shoulder pain and scores were obtained at 1, 6, 12, 24, and 48 h after LC.


There was no obvious difference in baseline characteristics as well as operative time, occurrence of bradycardia, or hospital stay between groups. The incidence of shoulder pain was not significantly different (group A 45.7% vs group B 48.6%, p = 0.866). However, the patients in group A with shoulder pain reported significantly less pain scores (p < 0.001) at 12 and 24 h after surgery, compared with those in group B.


Applying the strategy of low flow rate to induce pneumoperitoneum followed by high flow rate to maintain the pressure provides advantages to reduce the severity of shoulder pain for patients who underwent LC and then experienced shoulder pain.


Insufflation rate Laparoscopy Shoulder pain 


Author Contributions

1. Critical revision of the manuscript for important intellectual content: De-Chuan Chan, Cheng-Jueng Chen, and Jyh-Cherng Yu

2. Material support: Teng-Wei Chen, Chung-Bao Hsieh, and De-Chuan Chan

3. Study concept and design and analysis and interpretation of data, drafting of the manuscript, statistical analysis, and writing: Kuo-Feng Hsu, Si-Yuan Wu, Bao-Chung Chen, and Chih-Wei Yang

Compliance with Ethical Standards

All patients (64 men and 76 women) between 19 and 84 years of age (mean age, 56.9 years) were blinded and randomly divided into low flow rate (1 L/min) for induction followed by high flow rate (10 L/min) for maintaining 12 mmHg pneumoperitoneum (group A, n = 70) and the continuous high flow rate group (group B, n = 70) by computer-based sequential allocation.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  • Kuo-Feng Hsu
    • 1
  • Cheng-Jueng Chen
    • 1
    Email author
  • Jyh-Cherng Yu
    • 1
  • Si-Yuan Wu
    • 1
  • Bao-Chung Chen
    • 2
  • Chih-Wei Yang
    • 2
  • Teng-Wei Chen
    • 1
  • Chung-Bao Hsieh
    • 1
  • De-Chuan Chan
    • 1
    Email author
  1. 1.Division of General Surgery, Department of Surgery, Tri-Service General HospitalNational Defense Medical CenterTaipeiTaiwan
  2. 2.Division of Gastroenterology, Department of Medicine, Tri-Service General HospitalNational Defense Medical CenterTaipeiTaiwan

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