DEPENDENCE OF THE PAIN SYNDROME INTENSITY AFTER LAPAROSCOPIC SURGERY ON THE RESIDUAL VOLUME OF WORKING GAS IN THE ABDOMINAL CAVITY

Induction of pneumoperitoneum is a mandatory step in laparoscopic surgery in order to create a workspace for the surgeon. The cause of omalgia (pain in shoulder area) after such interventions isthe accumulation of residual gas in the abdominal cavity.There are still no proven methods of quantitative assessment of the residual pneumoperitoneum. Thus, the patterns of relationship between the amount of residual gas and the intensity of pain syndrome havenot been studiedyet.Considering the fact that the residual gas exerts mechanical distention of anatomical structures and apparently causes local irritation in the peritoneum, it is necessary to develop preventive measures for omalgia which may involve not only the ap-proaches to reduce the amount of residual gas but also the use of alternative gas sources, particularly argon. As inert gas argonpossessesmany positive qualities,it does not affect the peritoneum, and has no resorptive metabolic effects.The goalof ourresearchis to work outan X-ray planimetric method for determining the amount of residual gasafter laparoscopic surgery and to assess the dependence of the pain intensityonboth,the amount of residual gas and the type of working gasused.Material and methods of research. Two experimental groups of patients with uncomplicated chole-lithiasiswere formed, and carboxyperitoneum and argonperitoneum were used to create the space during laparoscopic cholecystectomy. The groups of examined patients are equivalent byage and sex andare randomized for consecutive admission to the hospital.Both groups include patientswho underwent surgerywithout the use of any drainage means. 24 hours after the operation, a chest plain radiographywas performed in order to identifythe area of gas crescent sign under the right hemidiaphragm usingpersonally-developed original approach.The tech-nique is based on the use of a mobile application to measure the area of complex geometric shapes. At the same time, the intensity of pain syndrome in the shoulder area was assessed in all the patients by means of NRS (Nu-meric Rating Scale) in combination with Rotterdam El-derly Pain Observation Scale (REPOS). The technique is aimed to objectify the subjective assessment of pain. Sta-tistical software forMicrosoft Excel 2010was used forprocessing thestudyresults and calculatingPearson'scorrelation coefficient.Results of research and their discussion.The obtained results revealed moderate correlation relationship between the area of gas crescent sign underthe right hem-idiaphragm and pain syndrome intensity. This relationship was confirmed both in the group with carboxyperitoneum and in the group with argon as the working gas. However, it was observedthat the proportion of patients with postoperative omalgia in the group with argonoperitoneum is significantly lower.Thus, both hypotheses, concerning the role of mechanical factors in the developmentof omalgic syndrome and the significanceof chemical local peritoneal irritation have beenconfirmed.Conclusions:1. The suggestedmethod of radiologicalplanimetry allows to obtaine thedigital indicators suitable for statistical analysis whichcharacterize the amount of residual gas after laparoscopic surgery.2. The intensity of pain syndrome exhibitscorrelation with the amount of residual gas after the surgery.3. The severityof omalgia depends primarily on the amount of residual gas. However, the incidence of omalgic syndrome with the use of carbon dioxide is higher than with argonuse.