A randomized controlled trial assessing the effect of heated carbon dioxide for insufflation on pain and recovery after laparoscopic fundoplication

Background: Insufflation with heated gas for laparoscopy may reduce postoperative pain. This study assessed the effect of heated gas on outcome after fundoplication. Methods: A blinded, randomized trial compared the effect of heated or standard carbon dioxide (CO2) on core temperature, postoperative pain, analgesic requirement, and postoperative recovery. Pain scores were assessed with a 100 mm visual analog scale (VAS). Recovery was assessed with a patient diary and clinical follow-up assessment at 8 days and 1 month postoperatively. Results: For this study, 40 patients were randomized to heated CO2 (n = 19) and standard CO2 (control) (n = 21), groups. The heated CO2 group increased core body temperature from 35.9 degrees to 36.1 degreesC, (p = 0.008), whereas the control group maintained core temperature at 35.8 degreesC. The control group had lower analgesic requirements and pain scores, significant at 12 h (VAS: 20 vs 36 mm; p = 0.04). There was no difference between the groups in terms of late recovery. The heated CO2 group showed a significant correlation between operative duration and requirement for postoperative morphine (p = 0.01). Conclusions: Heated gas provides no benefit for patients and may be associated with increased early pain. The elevation of core body temperature observed with heated CO2 is of little clinical significance.