Surgical Endoscopy

, Volume 27, Issue 7, pp 2283–2292 | Cite as

Intraperitoneal instillation of saline and local anesthesia for prevention of shoulder pain after laparoscopic cholecystectomy: a systematic review

  • Anders Meller Donatsky
  • Flemming Bjerrum
  • Ismail Gögenur
Review

Abstract

Background

The laparoscopic technique has many advantages compared with open surgery for symptomatic cholecystolithiasis. Despite these advantages, many patients complain about shoulder pain (SP) after laparoscopic cholecystectomy. The purpose of this review was to evaluate intraperitoneal instillation (IPI) of saline and local anesthesia (LA) to minimize SP.

Methods

A search of the literature was conducted using PubMed and Excerpta Medica Database (EMBASE). Eligibility criteria were: randomized clinical trials (RCT) evaluating IPI of saline and/or LA to minimize incidence or severity of SP after laparoscopic cholecystectomy. Only papers published in English were included. Data extracted were year of publication, number of participants and allocation, timing of IPI, and nonsignificant or significant effect on incidence or severity of SP.

Results

A total of 24 RCTs were included in the review. Four RCTs reported results on IPI saline as intervention versus nothing as control. Seven RCTs reported results on IPI LA as intervention versus nothing as control. Sixteen RCTs reported results on IPI LA as intervention versus saline as control. IPI saline resulted in a significant reduction in SP severity compared with nothing. IPI LA was associated with an overall significant reduction of SP severity compared with nothing. Results regarding the effect IPI LA versus saline showed contradictory results in regards to both SP incidence and severity.

Conclusions

Both IPI of saline and LA can be used to reduce SP severity after laparoscopic cholecystectomy. It is not possible to conclude whether the incidence of SP can be reduced with saline or LA, due to contradictive results.

Keywords

Laparoscopic cholecystectomy Shoulder pain Intraperitoneal instillation Saline Local anesthesia 

Notes

Conflict of interest

No funding was received for writing or publishing.

Disclosures

Anders Meller Donatsky, Flemming Bjerrum, and Ismail Gögenur have no conflict of interest or financial ties to disclose.

References

  1. 1.
    Bisgaard T, Kehlet H, Rosenberg J (2001) Pain and convalescence after laparoscopic cholecystectomy. Eur J Surg 167:84–96PubMedCrossRefGoogle Scholar
  2. 2.
    Kahokehr A, Sammour T, Soop M, Hill AG (2010) Intraperitoneal use of local anesthetic in laparoscopic cholecystectomy: systematic review and metaanalysis of randomized controlled trials. J Hepatobiliary Pancreat Sci 17:637–656PubMedCrossRefGoogle Scholar
  3. 3.
    Paulson J, Mellinger J, Baguley W (2003) The use of intraperitoneal bupivacaine to decrease the length of stay in elective laparoscopic cholecystectomy patients. Am Surg 69:275–278PubMedGoogle Scholar
  4. 4.
    Lauwick S, Kim do J, Michelagnoli G, Mistraletti G, Feldman L, Fried G, Carli F (2008) Intraoperative infusion of lidocaine reduces postoperative fentanyl requirements in patients undergoing laparoscopic cholecystectomy. Can J Anaesth 55:754–760PubMedCrossRefGoogle Scholar
  5. 5.
    Kim TH, Kang H, Hong JH, Park JS, Baek CW, Kim JY, Jung YH, Kim HK (2011) Intraperitoneal and intravenous lidocaine for effective pain relief after laparoscopic appendectomy: a prospective, randomized, double-blind, placebo-controlled study. Surg Endosc 25:3183–3190PubMedCrossRefGoogle Scholar
  6. 6.
    Alptekin H, Sahin M (2010) Gallbladder bed irrigation with bupivacaine improves pulmonary functions after laparoscopic cholecystectomy. Langenbecks Arch Surg 395:501–504PubMedCrossRefGoogle Scholar
  7. 7.
    Salihoglu Z, Yildirim M, Demiroluk S, Kaya G, Karatas A, Ertem M, Aytac E (2009) Evaluation of intravenous paracetamol administration on postoperative pain and recovery characteristics in patients undergoing laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech 19:321–323PubMedCrossRefGoogle Scholar
  8. 8.
    Moher D, Liberati A, Tetzlaff J, Altman DG (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8:336–341PubMedCrossRefGoogle Scholar
  9. 9.
    Tsimoyiannis EC, Siakas P, Tassis A, Lekkas ET, Tzourou H, Kambili M (1998) Intraperitoneal normal saline infusion for postoperative pain after laparoscopic cholecystectomy. World J Surg 22:824–828PubMedCrossRefGoogle Scholar
  10. 10.
    Barczynski M, Herman RM (2004) Low-pressure pneumoperitoneum combined with intraperitoneal saline washout for reduction of pain after laparoscopic cholecystectomy: a prospective randomized study. Surg Endosc 18:1368–1373PubMedCrossRefGoogle Scholar
  11. 11.
    Esmat ME, Elsebae MM, Nasr MM, Elsebaie SB (2006) Combined low pressure pneumoperitoneum and intraperitoneal infusion of normal saline for reducing shoulder tip pain following laparoscopic cholecystectomy. World J Surg 30:1969–1973PubMedCrossRefGoogle Scholar
  12. 12.
    Ahmed BH, Ahmed A, Tan D, Awad ZT, Al-Aali AY, Kilkenny J 3rd, Orlando FA, Al-Chalabi A, Crass R, Alrawi SJ (2008) Post-laparoscopic cholecystectomy pain: effects of intraperitoneal local anesthetics on pain control—a randomized prospective double-blinded placebo-controlled trial. Am Surg 74:201–209PubMedGoogle Scholar
  13. 13.
    Tsimoyiannis EC, Glantzounis G, Lekkas ET, Siakas P, Jabarin M, Tzourou H (1998) Intraperitoneal normal saline and bupivacaine infusion for reduction of postoperative pain after laparoscopic cholecystectomy. Surg Laparosc Endosc 8:416–420PubMedCrossRefGoogle Scholar
  14. 14.
    Gharaibeh KI, Al-Jaberi TM (2000) Bupivacaine instillation into gallbladder bed after laparoscopic cholecystectomy: does it decrease shoulder pain? J Laparoendosc Adv Surg Tech A 10:137–141PubMedCrossRefGoogle Scholar
  15. 15.
    Lee IO, Kim SH, Kong MH, Lee MK, Kim NS, Choi YS, Lim SH (2001) Pain after laparoscopic cholecystectomy: the effect and timing of incisional and intraperitoneal bupivacaine. Can J Anaesth 48:545–550PubMedCrossRefGoogle Scholar
  16. 16.
    Lepner U, Goroshina J, Samarutel J (2003) Postoperative pain relief after laparoscopic cholecystectomy: a randomised prospective double-blind clinical trial. Scand J Surg 92:121–124PubMedGoogle Scholar
  17. 17.
    Pappas-Gogos G, Tsimogiannis KE, Zikos N, Nikas K, Manataki A, Tsimoyiannis EC (2008) Preincisional and intraperitoneal ropivacaine plus normal saline infusion for postoperative pain relief after laparoscopic cholecystectomy: a randomized double-blind controlled trial. Surg Endosc 22:2036–2045PubMedCrossRefGoogle Scholar
  18. 18.
    El-Labban GM, Hokkam EN, El-Labban MA, Morsy K, Saadl S, Heissam KS (2011) Intraincisional vs intraperitoneal infiltration of local anaesthetic for controlling early post-laparoscopic cholecystectomy pain. J Minim Access Surg 7:173–177PubMedCrossRefGoogle Scholar
  19. 19.
    Chundrigar T, Hedges AR, Morris R, Stamatakis JD (1993) Intraperitoneal bupivacaine for effective pain relief after laparoscopic cholecystectomy. Ann R Coll Surg Engl 75:437–439PubMedGoogle Scholar
  20. 20.
    Joris J, Thiry E, Paris P, Weerts J, Lamy M (1995) Pain after laparoscopic cholecystectomy: characteristics and effect of intraperitoneal bupivacaine. Anesth Analg 81:379–384PubMedGoogle Scholar
  21. 21.
    Raetzell M, Maier C, Schroder D, Wulf H (1995) Intraperitoneal application of bupivacaine during laparoscopic cholecystectomy—risk or benefit? Anesth Analg 81:967–972PubMedGoogle Scholar
  22. 22.
    Szem JW, Hydo L, Barie PS (1996) A double-blinded evaluation of intraperitoneal bupivacaine vs saline for the reduction of postoperative pain and nausea after laparoscopic cholecystectomy. Surg Endosc 10:44–48PubMedCrossRefGoogle Scholar
  23. 23.
    Cunniffe MG, McAnena OJ, Dar MA, Calleary J, Flynn N (1998) A prospective randomized trial of intraoperative bupivacaine irrigation for management of shoulder-tip pain following laparoscopy. Am J Surg 176:258–261PubMedCrossRefGoogle Scholar
  24. 24.
    Elhakim M, Elkott M, Ali NM, Tahoun HM (2000) Intraperitoneal lidocaine for postoperative pain after laparoscopy. Acta Anaesthesiol Scand 44:280–284PubMedCrossRefGoogle Scholar
  25. 25.
    Labaille T, Mazoit JX, Paqueron X, Franco D, Benhamou D (2002) The clinical efficacy and pharmacokinetics of intraperitoneal ropivacaine for laparoscopic cholecystectomy. Anesth Analg 94:100–105PubMedGoogle Scholar
  26. 26.
    Louizos AA, Hadzilia SJ, Leandros E, Kouroukli IK, Georgiou LG, Bramis JP (2005) Postoperative pain relief after laparoscopic cholecystectomy: a placebo-controlled double-blind randomized trial of preincisional infiltration and intraperitoneal instillation of levobupivacaine 0.25 %. Surg Endosc 19:1503–1506PubMedCrossRefGoogle Scholar
  27. 27.
    Jabbour-Khoury SI, Dabbous AS, Gerges FJ, Azar MS, Ayoub CM, Khoury GS (2005) Intraperitoneal and intravenous routes for pain relief in laparoscopic cholecystectomy. JSLS 9:316–321PubMedGoogle Scholar
  28. 28.
    Barczynski M, Konturek A, Herman RM (2006) Superiority of preemptive analgesia with intraperitoneal instillation of bupivacaine before rather than after the creation of pneumoperitoneum for laparoscopic cholecystectomy: a randomized, double-blind, placebo-controlled study. Surg Endosc 20:1088–1093PubMedCrossRefGoogle Scholar
  29. 29.
    Kucuk C, Kadiogullari N, Canoler O, Savli S (2007) A placebo-controlled comparison of bupivacaine and ropivacaine instillation for preventing postoperative pain after laparoscopic cholecystectomy. Surg Today 37:396–400PubMedCrossRefGoogle Scholar
  30. 30.
    Alper I, Ulukaya S, Ertugrul V, Makay O, Uyar M, Balcioglu T (2009) Effects of intraperitoneal levobupivacaine on pain after laparoscopic cholecystectomy: a prospective, randomized, double-blinded study. AGRI 21:141–145PubMedGoogle Scholar
  31. 31.
    Cha SM, Kang H, Baek CW, Jung YH, Koo GH, Kim BG, Choi YS, Cha SJ, Cha YJ (2012) Peritrocal and intraperitoneal ropivacaine for laparoscopic cholecystectomy: a prospective, randomized, double-blind controlled trial. J Surg Res 175:251–258PubMedCrossRefGoogle Scholar
  32. 32.
    Hilvering B, Draaisma WA, van der Bilt JD, Valk RM, Kofman KE, Consten EC (2011) Randomized clinical trial of combined preincisional infiltration and intraperitoneal instillation of levobupivacaine for postoperative pain after laparoscopic cholecystectomy. Br J Surg 98:784–789PubMedCrossRefGoogle Scholar
  33. 33.
    Al Shehri MY (1999) Radiological evaluation of patients after laparoscopic cholecystectomy. Saudi J Gastroenterol 5:23–26PubMedGoogle Scholar
  34. 34.
    Draper K, Jefson R, Jongeward R Jr, McLeod M (1997) Duration of postlaparoscopic pneumoperitoneum. Surg Endosc 11:809–811PubMedCrossRefGoogle Scholar
  35. 35.
    Jackson SA, Laurence AS, Hill JC (1996) Does post-laparoscopy pain relate to residual carbon dioxide? Anaesthesia 51:485–487PubMedCrossRefGoogle Scholar
  36. 36.
    Kandil TS, El Hefnawy E (2010) Shoulder pain following laparoscopic cholecystectomy: factors affecting the incidence and severity. J Laparoendosc Adv Surg Tech A 20:677–682PubMedCrossRefGoogle Scholar
  37. 37.
    Wallace DH, Serpell MG, Baxter JN, O’Dwyer PJ (1997) Randomized trial of different insufflation pressures for laparoscopic cholecystectomy. Br J Surg 84:455–458PubMedCrossRefGoogle Scholar
  38. 38.
    Peter LW, Roger W, Mary D (1989) Biliary duct and gallbladder. Gray’s anatomy. Churchill Livingstone, London, pp 1394–1395Google Scholar
  39. 39.
    Semm K, Arp WD, Trappe M, Kube D (1994) Pain reduction after pelvi/-laparoscopic interventions by insufflation of CO2 gas at body temperature (Flow-Therme). Geburtshilfe Frauenheilkd 54:300–304PubMedCrossRefGoogle Scholar
  40. 40.
    Michaloliakou C, Chung F, Sharma S (1996) Preoperative multimodal analgesia facilitates recovery after ambulatory laparoscopic cholecystectomy. Anesth Analg 82:44–51PubMedGoogle Scholar
  41. 41.
    Ng A, Parker J, Toogood L, Cotton BR, Smith G (2002) Does the opioid-sparing effect of rectal diclofenac following total abdominal hysterectomy benefit the patient? Br J Anaesth 88:714–716PubMedCrossRefGoogle Scholar
  42. 42.
    Kahokehr A, Sammour T, Vather R, Taylor M, Stapelberg F, Hill AG (2010) Systemic levels of local anaesthetic after intraperitoneal application—a systematic review. Anaesth Intensive Care 38:623–638PubMedGoogle Scholar
  43. 43.
    Gurusamy KS, Samraj K, Mullerat P, Davidson BR (2007) Routine abdominal drainage for uncomplicated laparoscopic cholecystectomy. Cochrane Database Syst Rev 4:CD006004Google Scholar
  44. 44.
    Feroci F, Kroning KC, Scatizzi M (2009) Effectiveness for pain after laparoscopic cholecystectomy of 0.5 % bupivacaine-soaked Tabotamp placed in the gallbladder bed: a prospective, randomized, clinical trial. Surg Endosc 23:2214–2220PubMedCrossRefGoogle Scholar
  45. 45.
    Fu JZ, Li J, Yu ZL (2009) Effect of implanting fibrin sealant with ropivacaine on pain after laparoscopic cholecystectomy. World J Gastroenterol 15:5851–5854PubMedCrossRefGoogle Scholar
  46. 46.
    Verma GR, Lyngdoh TS, Kaman L, Bala I (2006) Placement of 0.5 % bupivacaine-soaked Surgicel in the gallbladder bed is effective for pain after laparoscopic cholecystectomy. Surg Endosc 20:1560–1564PubMedCrossRefGoogle Scholar
  47. 47.
    Narchi P, Benhamou D, Bouaziz H, Fernandez H, Mazoit JX (1992) Serum concentrations of local anaesthetics following intraperitoneal administration during laparoscopy. Eur J Clin Pharmacol 42:223–225PubMedCrossRefGoogle Scholar
  48. 48.
    Ahn Y, Woods J, Connor S (2011) A systematic review of interventions to facilitate ambulatory laparoscopic cholecystectomy. HPB (Oxford) 13:677–686CrossRefGoogle Scholar
  49. 49.
    Qadan M, Dajani D, Dickinson A, Polk HC Jr (2010) Meta-analysis of the effect of peritoneal lavage on survival in experimental peritonitis. Br J Surg 97:151–159PubMedCrossRefGoogle Scholar
  50. 50.
    Afshar S, Kurer MA (2012) Laparoscopic peritoneal lavage for perforated sigmoid diverticulitis. Colorectal Dis 14:135–142PubMedCrossRefGoogle Scholar
  51. 51.
    Schulz KF, Altman DG, Moher D (2011) CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. Int J Surg 9:672–677PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Anders Meller Donatsky
    • 1
  • Flemming Bjerrum
    • 2
  • Ismail Gögenur
    • 1
  1. 1.Department of Surgery, Center for Perioperative OptimizationHerlev Hospital, University Hospital of CopenhagenHerlevDenmark
  2. 2.Department of Obstetrics and Gynaecology, Juliane Marie Centre, Centre for Women, Children and Reproduction, RigshospitaletUniversity Hospital of CopenhagenCopenhagenDenmark

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