Background: Pneumoperitoneum plays an important role in introducing post-laparoscopic pain. Total gas volume insufflation might be more important and not related to the length of the procedure. It is an important factor that increases residual pneumoperitoneum and should be taken under consideration along pressure setting and flow rate.

Aim: To examine the effect of different total carbon dioxide volume insufflation on postoperative abdominal and shoulder tip pain in terms of severity and development time.

Methods: A prospective observational study was conducted on 119 patients who underwent elective laparoscopic cholecystectomy. Patients were allocated into four groups “low, moderate, high, and extremely high” volume carbon dioxide groups depending on the amount of gas used. Postoperative pain was measured using a numerical rating scales (NRS); no pain (0), mild pain (1,2,3), moderate pain (4,5,6) and severe pain (7,8,9,10) at 2, 6, and 24 hours postoperatively.

Results: Postoperative abdominal pain was significantly lower in the “low volume group” in early postoperative hours, although there was no significant difference (P=0.73) in late postoperative hours. There was no significant difference in postoperative shoulder pain in early hours (P=0.78); however, the shoulder pain started to increase 6 hours after operation more in “high volume groups”.

Conclusion: The total CO2 volume insufflation can be regarded as an important factor in the etiology of post-laparoscopic pain.

Keywords: Pneumoperitoneum; insufflation, total volume; abdominal pain; shoulder pain