Am J Surg. 2026 Apr 28;258:117013. doi: 10.1016/j.amjsurg.2026.117013. Online ahead of print.
ABSTRACT
BACKGROUND: Postoperative abdominal and shoulder pain, nausea, and vomiting are among the most common complications following laparoscopic surgery, often necessitating increased use of analgesics and antiemetics. This study aimed to compare the effects of nitrous oxide (N2O) and positional maneuvers on pain intensity, incidence of nausea and vomiting, and analgesic requirements after laparoscopic surgery.
MATERIALS AND METHODS: This double-blind randomized clinical trial was conducted on 126 elective patients scheduled for laparoscopic cholecystectomy. The patients were randomly assigned into three groups of 42 individuals each: one group received N2O, another received a combination of positional maneuver and pulmonary recruitment, and the third served as the control group. Pain intensity, nausea, vomiting, and time to first analgesic request were assessed at 6, 12, and 24 h postoperatively. Data were analyzed using ANOVA, Chi-square, and Fisher’s exact tests. A p-value of less than 0.05 was considered statistically significant. All analyses were performed using SPSS software, version 24.
RESULTS: The results showed that the N2O group experienced the lowest intensity of abdominal and shoulder pain at all time points, and the time to first analgesic request was significantly longer in this group than the others (p < 0.05). Additionally, the incidence of nausea and vomiting was lower in the intervention groups than in the control group, and this difference was statistically significant (p < 0.05). Among the demographic variables, gender was the only factor associated with the occurrence of complications; females experienced vomiting more frequently than males.
CONCLUSION: Both nitrous oxide and positional maneuvers effectively reduced postoperative pain and gastrointestinal complications, with N2O showing greater efficacy in minimizing symptoms and delaying analgesic need.
PMID:42092289 | DOI:10.1016/j.amjsurg.2026.117013
