Javad Hashemi, Hoseinali Soltani , Ali Esmaeili , Fatemeh Roshanravan Yazdi , Seyed Hassan Seyed Sharifi ,
Volume 83, Issue 4 (7-2025)
Abstract
Background: Postoperative pain is a significant concern after cholecystectomy. Given the role of vitamin D in pain management, this study investigated the correlation between preoperative vitamin D levels and postoperative pain severity in patients undergoing laparoscopic cholecystectomy, with the aim of improving pain management and enhancing postoperative care.
Methods: This prospective observational study (January 2024- February 2025) was conducted on 87 patients undergoing laparoscopic cholecystectomy at Imam Ali Hospital of Bojnurd. Inclusion criteria were age 18-45, non-urgent laparoscopic cholecystectomy, and good physical status. Exclusion criteria were chronic pain, regular analgesic use, known psychiatric or neurological disease or treatment, substance abuse, emergency cholecystectomy, or conversion to open surgery. Participants fasted for 12 hours preoperatively. All received 1 g (IV) ceftriaxone one hour before and 12 hours after surgery. Anesthesia was induced with propofol and fentanyl and maintained with isoflurane, nitrous oxide, or oxygen. Anesthesia and surgical technique were standardized, with any deviations recorded. We collected demographic data and extracted perioperative details from records and interviews. Pre-induction venous blood samples were collected, processed, and stored at -20°C. Serum vitamin D concentrations were quantified via ELISA method, and participants were subsequently stratified into two groups based on these measurements. Postoperative pain was assessed on a Visual Analog Scale (0-10) at 6, 12, 18, and 24 hours. Analgesic regimens followed standard protocol under physician supervision and were unaffected by the study.
Results: Lower serum vitamin D levels were associated with higher postoperative pain scores (P<0.01), with this relationship being significant at 6, 12, and 18 hours postoperatively (P<0.01, P<0.01, and P<0.05, respectively). Insufficient vitamin D levels and female gender were also independent risk factors for acute pain after laparoscopic cholecystectomy (P<0.01).
Conclusion: Based on the results of the present study, preoperative vitamin D deficiency is associated with increased postoperative acute pain scores in patients undergoing laparoscopic cholecystectomy, especially in women. These findings may be useful for postoperative pain management in patients with vitamin D deficiency.
Majid Vatankhah Tarbebar , Saeid Kashani, Milad Mohammadi , Zohreh Nik Eghbali, Mehrdad Malekshoar,
Volume 83, Issue 6 (9-2025)
Abstract
Background: Laparoscopic cholecystectomy is the gold standard for treating gallbladder diseases; however, it is associated with physiological challenges from pneumoperitoneum and specific patient positioning. Positive end-expiratory pressure (PEEP) may mitigate these effects, but the optimal level remains uncertain. This study compared the impact of three PEEP levels on respiratory performance and hemodynamic stability during laparoscopic cholecystectomy.
Methods: This randomized double-blind clinical trial was conducted at Shahid Mohammadi Hospital, Bandar Abbas, Iran, from August 2023 to February 2024. A total of 75 adult patients aged 18-70 years with ASA class I-II scheduled for elective laparoscopic cholecystectomy were assigned to three groups (n=25 each): PEEP 0 cmH₂O (control), PEEP 5 cmH₂O, and PEEP 7 cmH₂O. Standardized general anesthesia and mechanical ventilation with tidal volumes of 6-8 mL/kg were applied. Hemodynamic variables (mean arterial pressure, heart rate) and respiratory parameters (SpO₂, EtCO₂) were recorded before intubation, during intubation, and at 15, 30, and 60 minutes post-intubation, as well as in the recovery room. Arterial blood gas analysis was performed 30 minutes after intubation. Data were analyzed using ANOVA and chi-square tests with a significance level of 0.05.
Results: The mean age of patients was 41.89±11.39 years, and baseline demographic variables showed no significant differences among groups. Oxygen saturation remained above 94% across all time points without intergroup differences. EtCO₂ values differed significantly at 30 minutes (P=0.04) and 60 minutes (P=0.01), with the highest levels observed in the PEEP 7 group and the lowest in the PEEP 5 group. Although mean arterial pressure and heart rate did not show statistically significant variation among groups, the PEEP 7 group demonstrated the smallest postoperative decline in blood pressure.
Conclusion: A PEEP level of 5 cmH₂O offers the most favorable balance between maintaining oxygenation, supporting effective ventilation, and preserving hemodynamic stability during laparoscopic cholecystectomy. This level can be recommended as a safe and optimal ventilation strategy.
