Journal of Minimal Access Surgery

LETTER TO THE EDITOR
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Year : 2021  |  Volume : 17  |  Issue : 3  |  Page : 421--422

The story behind the time characteristics of shoulder pain after laparoscopic surgery

Xinyou Li1, Kezhong Li2,  
1 Department of Anesthesiology, School of Medicine, Shandong University, Jinan; Department of Anesthesiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, China
2 Department of Anesthesiology, School of Medicine, Shandong University, Jinan; Department of Anesthesiology, Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China

Correspondence Address:
Dr. Kezhong Li
Department of Anesthesiology, School of Medicine, Shandong University, 44 Wenhua West Road, Jinan, Shandong 250012
China




How to cite this article:
Li X, Li K. The story behind the time characteristics of shoulder pain after laparoscopic surgery.J Min Access Surg 2021;17:421-422


How to cite this URL:
Li X, Li K. The story behind the time characteristics of shoulder pain after laparoscopic surgery. J Min Access Surg [serial online] 2021 [cited 2022 Aug 8 ];17:421-422
Available from: https://www.journalofmas.com/text.asp?2021/17/3/421/310495


Full Text

Dear Sir,

We note that previous studies have found that the temporal characteristics of shoulder pain after laparoscopic surgery (PLSP) are significantly different from incision pain and visceral pain.[1] The pain of incision and visceral reached the peak immediately after the operation, and then gradually alleviated. The incidence rate and severity of PLSP reached the peak on the 1st day after the operation or 12–24 h after operation. More interestingly, most of the intervention studies did not change this temporal feature of PLSP. We also found this temporal characteristic through a clinical observational study. Further observation and study found that most patients began to have shoulder pain after getting out of bed for the first time. In our hospital, all our patients begin to get out of bed on the 1st day (12–24 h) after the surgery.

PLSP is an important part of pain after laparoscopic surgery. The etiology of postlaparoscopy pain is multifactorial. At present, most scholars believe that the pathogenesis of PLSP is related to the stimulation of phrenic nerve by pneumoperitoneum or postoperative residual gas.[2],[3],[4]

After laparoscopic surgery, we searched for free gas in the abdominal cavity by abdominal X-ray plain film, colour Doppler ultrasound and computed tomography. We found that when the patients were lying on their back after operation, the abdominal gas mainly accumulated under the anterior abdominal wall. When the patient got out of bed, the gas accumulated under the anterior abdominal wall disappeared, and the abdominal gas mainly accumulated under the diaphragm. This seems to explain why shoulder pain occurs after a change in position. When the patient is in the supine position, the gas accumulated under the anterior abdominal wall will not stimulate the phrenic nerve. When the patient is transferred to the standing position, the gas is transferred to the lower part of the diaphragm to gather and stimulate the phrenic nerve to cause shoulder pain.

In some hospitals, laparoscopic surgery is outpatient or day surgery. The patient began to get out of bed shortly after the operation. Previous studies have not described when patients begin to get out of bed. Therefore, these studies did not compare the incidence and severity of PLSP before and after postural changes. Therefore, in future research, we should pay attention to the PLSP before and after the patient's posture change. We cannot just take the fixed time point as the evaluation opportunity. To reduce the incidence of PLSP or reduce the severity of PLSP, appropriate intervention measures should be given before patients' posture changes.

Although the reported incidence of PLSP varies widely based on previous studies, the literature reports ranged from 30% to 90%.[5],[6] Because there are so many people undergoing laparoscopic surgery now, 8000 patients in our hospital alone receive laparoscopic surgery every year. Therefore, even if we estimate the lowest proportion, there are still many patients suffering from this problem. This is worthy of our great attention.

Understanding the story behind the temporal characteristics of PLSP can help us better deal with this clinical problem.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

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2Nyerges A. Pain mechanisms in laparoscopic surgery. Semin Laparosc Surg 1994;1:215-8.
3Mouton WG, Bessell JR, Otten KT, Maddern GJ. Pain after laparoscopy. Surg Endosc 1999;13:445-8.
4Jackson SA, Laurence AS, Hill JC. Does postlaparoscopy pain relate to residual carbon dioxide? Anaesthesia 1996;51:485-7.
5Dixon JB, Reuben Y, Halket C, O'Brien PE. Shoulder pain is a common problem following laparoscopic adjustable gastric band surgery. Obes Surg 2005;15:1111-7.
6Chaichian S, Moazzami B, Haghgoo A, Sheibani K. A new approach to an old concept for reducing shoulder pain caused by gynecological laparoscopy. J Reprod Infertil 2018;19:56-60.