Preoperative Acetazolamide

Pain control following surgery is integral to surgical success, allowing faster recovery and return to function and increasing patient satisfaction. Minimally invasive surgery, such as laparoscopy, is becoming increasingly common as it involves smaller incisions and theoretically less discomfort. However, in order to perform laparoscopy, one must insufflate the abdomen with gas in order to create space in which to operate. The most commonly used gas today is carbon dioxide, as it is highly soluble and reduces the risk of air embolism compared to room air if absorbed. A consequence of using carbon dioxide is that it is converted to carbonic acid that can be irritating to the peritoneum and specifically the diaphragm, causing referred pain to the right subscapular (shoulder) region. Multiple strategies have been undertaken to help reduce this discomfort, one of which is using acetazolamide (a carbonic anhydrase inhibitor) to help reduce peritoneal acidification. Multiple studies have demonstrated an improvement in shoulder pain following preoperative administration in laparoscopic cholecystectomy, but studies evaluating use in pelvic surgery have had mixed results. The goal of this study is to add to this understanding and determine if acetazolamide is a useful adjunct to current pain control methods in laparoscopic gynecologic surgery.

Inclusion criteria

• Women
• Ages 21-65
• undergoing total laparoscopic hysterectomy (TLH) for benign indications with or without bilateral salpingoophorectomy
• undergoing total laparoscopic hysterectomy (TLH) for benign indications with or without cystoscopy

Exclusion criteria

• Allergy to acetazolamide or sulfonamides
• Known electrolyte disturbances
• Pregnancy
• Kidney failure or creatinine >1.5
• Diuretic or lithium use
• Chronic obstructive pulmonary disease (COPD) or other lung disease
• Central nervous system disorders
• Liver disease
• Glaucoma
• Preoperative or chronic opioid use
• Diagnosis of fibromyalgia
• Preoperative shoulder pain
• Conversion to laparotomy
• Intraoperative bladder or bowel injury
• Inability to understand or utilize visual analog scale
• Undergoing concurrent reconstructive procedures