Acetazolamide reduces referred postoperative pain after laparoscopic surgery with carbon dioxide insufflation. Anesthesiology 2003 Oct;99(4):924-8
Date
09/26/2003Pubmed ID
14508327DOI
10.1097/00000542-200310000-00027Scopus ID
2-s2.0-0141655153 (requires institutional sign-in at Scopus site) 21 CitationsAbstract
BACKGROUND: Carbon dioxide is the preferred insufflating gas for laparoscopy because of greater safety in the event of intravenous embolism, but it causes abdominal and referred pain. Acidification of the peritoneum by carbonic acid may be the major cause of pain from carbon dioxide insufflation. Carbonic anhydrase is an enzyme that increases the rate of carbonic acid formation from carbon dioxide. Because acetazolamide inhibits carbonic anhydrase, the authors hypothesized that the pain caused by carbon dioxide insufflation may be decreased by the administration of acetazolamide.
METHODS: A prospective, randomized, double-blind study of 38 patients undergoing laparoscopic surgery during general anesthesia was performed. Acetazolamide (5 mg/kg) or a saline placebo was administered intravenously during surgery. Pain was rated on a visual analog scale (0-10) at four times: when first awake, at discharge from the recovery room, when discharged from the hospital, and on the day after surgery. The site and quality of pain were recorded, as were medications and side effects.
RESULTS: Initial referred pain scores were lower after acetazolamide (1.00 +/- 1.98; n = 18) than after placebo (3.40 +/- 3.48; n = 20; P = 0.014), and 78% of patients in the acetazolamide group had no referred pain; however, only 45% patients in the placebo group had no referred pain. Incisional pain scores were not statistically different, and referred pain scores were similar at later times.
CONCLUSIONS: Acetazolamide reduces referred but not incisional pain after laparoscopic surgical procedures. The duration of pain reduction is limited to the immediate postsurgical period.
Author List
Woehlck HJ, Otterson M, Yun H, Connolly LA, Eastwood D, Colpaert KAuthors
Lois A. Connolly MD Professor in the Anesthesiology department at Medical College of WisconsinMary F. Otterson MD Professor in the Surgery department at Medical College of Wisconsin
Harvey J. Woehlck MD Professor in the Anesthesiology department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AcetazolamideAdult
Carbon Dioxide
Double-Blind Method
Humans
Insufflation
Laparoscopy
Logistic Models
Odds Ratio
Pain, Postoperative
Postoperative Care
Prospective Studies
