Unmodifiable Clinicopathological Risk Factors of Shoulder Tip or Subcostal Pain after Laparoscopic Appendectomy

Association between postoperative shoulder pain and left-side laparoscopic urologic surgery: a single-center retrospective cohort study

PURPOSE

Postoperative shoulder pain is a common problem after laparoscopic surgery. This study aimed to investigate the association between operative side and postoperative shoulder pain following urologic laparoscopic surgery performed in the lateral recumbent position.

METHODS

This was a retrospective cohort study conducted at a single tertiary care center. A total of 506 patients who underwent urologic laparoscopic surgery (including adrenalectomy, radical nephrectomy, partial nephrectomy, and pyeloplasty) between January 2010 and December 2019 were included. Patients who underwent total nephroureterectomy or resection of other organs were excluded. The primary outcome was the incidence of postoperative shoulder pain. A multivariable logistic regression analysis investigated the association between the operative side and postoperative shoulder pain.

RESULTS

Among the 506 included patients, there were an equal number of surgeries on the left and right sides. Eighty-eight patients had postoperative shoulder pain. The incidence of postoperative shoulder pain in the left-side group was significantly higher than that in the right-side group (21.3% [54/253] versus 13.4% [34/253], crude odds ratio = 1.75, 95% confidence interval [CI] 1.07-2.89). After adjustment for potential confounders (age, sex, body mass index, operation duration, operative technique, epidural block, peripheral nerve block, American Society of Anesthesiologists physical status classification, and intraoperative rocuronium dose), the left operative side was found to be associated with postoperative shoulder pain (adjusted odds ratio = 1.89, 95% CI 1.15-3.09).

CONCLUSION

The left operative side is associated with an increased incidence of postoperative shoulder pain after urologic laparoscopic surgery performed in the lateral recumbent position.

Use of intraoperative mild hyperventilation to decrease the incidence of postoperative shoulder pain after laparoscopic gastric sleeve surgery: A prospective randomised controlled study

BACKGROUND AND AIMS

Post-laparoscopic shoulder pain (PLSP) is a common problem. It is a referred type of pain resulting from irritation of phrenic nerve endings. Multiple manoeuvres were used to decrease its incidence with varying success rates. In this study, we tested the use of mild intraoperative hyperventilation to reduce PLSP in patients undergoing laparoscopic sleeve gastrectomy surgery (LSG).

METHODS

Consenting American Society of Anesthesiologists-I and II patients undergoing LSG under general anaesthesia were randomly assigned to two groups. Group A (53 patients) received intraoperative mild hyperventilation with target end-tidal carbon dioxide (ETCO2) of 30-32 mmHg. Group B (51 patients) received conventional ventilation (ETCO2 of 35-40 mmHg). Incidence and severity of PLSP, cumulative analgesic requirements and incidence of nausea and vomiting were recorded at 12 and 24 hours postoperatively and then followed up after discharge over the phone at 48 hours, 1 week, 1 month and 3 months. Statistical significance of differences between the two groups was defined at P < 0.05.

RESULTS

Incidence of PLSP was comparable between the two groups in the first 24 hours. The intervention group had a significantly lower incidence of PLSP throughout the remaining assessment points (56.6% vs. 80.4%, 30.2% vs. 78.4%, 15.1% vs. 70.6%, 3.8% vs. 35.3% at 36 hours, 48 hours, 1 week and 1 month, respectively, P < 0.05). The average PLSP pain score was significantly lower in the mild hyperventilation group at all assessment time points. Nausea and vomiting were non-significantly lower in the mild hyperventilation group.

CONCLUSION

Mild intraoperative hyperventilation could be beneficial in reducing the incidence and severity of PLSP after LSG surgery.

Postoperative Shoulder Pain after Laparoscopic Surgery

We often encounter patients complaining of shoulder pain after laparoscopic surgery. The pain mechanism is believed to be due to the diaphragmatic overstretching under pressure in a pneumoperitoneum, which causes referred pain to the shoulder, but the exact mechanism has not been clarified.