Meta-analysis of warmed versus standard temperature CO₂ insufflation for laparoscopic cholecystectomy

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• 作者：Abdul R. Hakeem ; Theodore Birks ; Qasim Azeem ; Filippo Di Franco ; Szabolcs Gergely ; Adrian M. Harris ; ^{adrianharris@nhs.net" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Laparoscopic cholecystectomy ; Carbon dioxide ; Pneumoperitoneum ; CO2 ; Warmed ; Humidified
• 刊名：The Surgeon
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：14
• 期：3
• 页码：164-173
• 全文大小：963 K

文摘

There is conflicting evidence for the use of warmed, humidified carbon dioxide (CO₂) for creating pneumoperitoneum during laparoscopic cholecystectomy. Few studies have reported less post-operative pain and analgesic requirement when warmed CO₂ was used.

Aim

This systematic review and meta-analysis aims to analyse the literature on the use of warmed CO₂ in comparison to standard temperature CO₂ during laparoscopic cholecystectomy.

Methods

Systematic review and meta-analysis carried out in line with the PRISMA guidelines. Primary outcomes of interest were post-operative pain at 6 h, day 1 and day 2 following laparoscopic cholecystectomy. Secondary outcomes were analgesic usage and drop in intra-operative core body temperature. Standard Mean Difference (SMD) was calculated for continuous variables.

Results

Six randomised controlled trials (RCTs) met the inclusion criteria (n = 369). There was no significant difference in post-operative pain at 6 h [3 RCTs; SMD = −0.66 (−1.33, 0.02) (Z = 1.89) (P = 0.06)], day 1 [4 RCTs; SMD = −0.51 (−1.47, 0.44) (Z = 1.05) (P = 0.29)] and day 2 [2 RCTs; SMD = −0.96 (−2.30, 0.37) (Z = 1.42) (P = 0.16)] between the warmed CO₂ and standard CO₂ group. There was no difference in analgesic usage between the two groups, but pooled analysis was not possible. Two RCTs reported significant drop in intra-operative core body temperature, but there were no adverse events related to this.

Conclusions

This review showed no difference in post-operative pain and analgesic requirements between the warmed and standard CO₂ insufflation during laparoscopic cholecystectomy. Currently there is not enough high quality evidence to suggest routine usage of warmed CO₂ for creating pneumoperitoneum during laparoscopic cholecystectomy.