Indian Journal of Surgery

, Volume 77, Supplement 2, pp 381–384

Shoulder Tip Pain Following Laparoscopic Cholecystectomy—a Randomized Control Study to Determine the Cause

Original Article

Abstract

The aim of this study was to determine the effect of low-pressure pneumoperitoneum and duration of surgery in laparoscopic cholecystectomy on postoperative shoulder tip pain. A total of 100 patients were assigned into two groups depending on the intraperitoneal pressure during laparoscopic cholecystectomy. Group A included patients in whom the intraperitoneal pressure was 13–15 mm of Hg and group B included patients who underwent surgery at 10–12 mmHg. Each group was then subdivided into two subgroups depending on the duration of surgery. In the first subgroup, the duration of surgery was less than 1 h and the next subgroup included patients who took more than 1 h. Presence or absence of shoulder tip pain was recorded within 4 h, at 24 h, and at 48 h. Total number of patients having shoulder tip pain in the lower pneumoperitoneal group was more than the higher pneumoperitoneal group in both subgroups, P values >0.05. More patients in the <1 h subgroup had shoulder tip pain as compared to the >1 h group at both pneumoperitoneal groups, P values >0.05. Shoulder tip pain was most at 24 h and gradually decreased thereafter. In our study, intra-abdominal pressures and shorter duration of surgery were factors unrelated to incidence of shoulder tip pain after laparoscopic cholecystectomy.

Keywords

Shoulder pain Laparoscopic cholecystectomy Pneumoperitoneal pressure 

References

  1. 1.
    Cunniffe MG, McAnena OJ, Dar MA (1998) A prospective randomized trial of intraoperative bupivacaine irrigation for management of shoulder-tip pain following laparoscopy. Am J Surg 176:258–261PubMedCrossRefGoogle Scholar
  2. 2.
    Berberoglu M, Dilek ON, Ercan F (1998) The effect of CO2 insufflation rate on the postlaparoscopic shoulder pain. J Laparoendosc Adv Surg Tech A 8:273–277PubMedCrossRefGoogle Scholar
  3. 3.
    Kanwer DB, Kaman L, Nedounsejiane M, Medhi B, Verma GR, Bala I (2009) Comparative study of low pressure versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy: a randomised controlled trial. Trop Gastroenterol 30(3):171–174PubMedGoogle Scholar
  4. 4.
    Rubinstein LM, Lebherz TB, Kleinkopf V (1976) Laparoscopic tubal sterilization: long-term postoperative follow-up. Contraception 13:631–638PubMedCrossRefGoogle Scholar
  5. 5.
    Dixon JB, Reuben Y, Halket C, O’Brien PE (2005) Shoulder pain is a common problem following laparoscopic adjustable gastric band surgery. Obes Surg 15(8):1111–1117PubMedCrossRefGoogle Scholar
  6. 6.
    Joris J, Thiry E, Paris I, Weerts J, Lamy M (1995) Pain after laparoscopic cholecystectomy: characteristics and effect of intraperitoneal bupivacaine. Anesth Analg 81:379–384PubMedGoogle Scholar
  7. 7.
    Alam MS, Hoque HW, Saifullah M, Ali MO (2009) Port site and intraperitoneal infiltration of local anesthetics in reduction of postoperative pain after laparoscopic cholecystectomy. Med Today 22(1):24–28Google Scholar
  8. 8.
    Sarli L, Costi R, Sansebastiano G, Trivelli M, Roncoroni L (2000) Prospective randomized trial of low pressure pneumoperitoneum for the reduction of shoulder tip pain following laparoscopy. Br J Surg 87:1161–1165PubMedCrossRefGoogle Scholar
  9. 9.
    Bhardwaj N, Sharma V, Chari P (2002) Intraperitoneal bupivacaine instillation for postoperative pain relief after laparoscopic cholecystectomy. Indian J Anaesth 46(1):49–52Google Scholar
  10. 10.
    Lepner U, Goroshina J, Samarütel J (2003) Postoperative pain relief after laparoscopic cholecystectomy: a randomised prospective double-blind clinical trial. Scand J Surg 92:121–124PubMedGoogle Scholar
  11. 11.
    Kandil TS, El Hefnawy E (2010) Shoulder pain following laparoscopic cholecystectomy: factors affecting the incidence and severity. J Laparoendosc Adv Surg Tech A 20(8):677–682PubMedCrossRefGoogle Scholar
  12. 12.
    Barczyñski M, Herman RM (2003) A prospective randomized trial on comparison of low pressure and standard pressure pneumoperitoneum for laparoscopic cholecystectomy. Surg Endosc 17:533–538PubMedCrossRefGoogle Scholar
  13. 13.
    Barczyñski M, Herman RM (2002) The usefulness of low pressure pneumoperitoneum in laparoscopic surgery. Folia Med Cracow 43:43–50Google Scholar
  14. 14.
    Davidas D, Birbs K, Vezakis A, Mcmohan MJ (1999) Routine low pressure pneumoperitoneum during laparoscopic cholecystectomy. Surg Endosc 13:87–89Google Scholar
  15. 15.
    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
  16. 16.
    Perrakis E, Vezakis A, Velimexis G, Savanis G, Deverakis S, Antoniades J (2003) Randomized comparison between different insufflation pressure for laparoscopic cholecystectomy. Surg Laparo Endosc Percutan Tech 13:245–249CrossRefGoogle Scholar
  17. 17.
    Yeh CC, Ko SC, Huh BK, Kuo CP, Wu CT, Cherng CH, Wong CS (2008) Shoulder tip pain after laparoscopic surgery analgesia by collateral meridian acupressure (shiatsu) therapy: a report of 2 cases. J Manipulative Physiol Ther 31(6):484–488PubMedCrossRefGoogle Scholar

Copyright information

© Association of Surgeons of India 2013

Authors and Affiliations

  1. 1.Department of General SurgerySir Ganga Ram HospitalNew DelhiIndia
  2. 2.Department of General Surgery, Sir Ganga Ram HospitalNew DelhiIndia

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