Analysis of risk factors of postlaparoscopic shoulder pain

Abstract

Aim: Postlaparoscopic shoulder pain (SP), mainly caused by pneumoperitoneum with CO 2 , sometimes suffers patients. This study was aimed to analyze the backgrounds of SP after gynecologic laparoscopy to clarify the risk of SP. Methods: We analyzed answers of questionnaire about the degree of SP from 696 patients undergoing gynecologic laparoscopic surgery since 2014-2018. The questionnaire asks the degree of SP with numeric rating scale from 0 to 10, before and 3 days after operation. We defined cases in which postoperative score elevated more than three compared to preoperative score as SP(+). Analyzed backgrounds were age, parity, body mass index, operative method, operative duration and amount of hemorrhage. Statistics was performed by Fisher exact analysis as univariate analysis, and with logistic regression as multivariate analysis. All laparoscopic surgeries were performed under 10-12 mmHg in pressure of pneumoperitoneum with CO 2 . Results: Univariate analysis revealed categories 'less than 50 years old', and 'over 2 h' and 'over 3 h' in operative duration resulted significant high rate of SP(+). For these three factors, multivariate analysis resulted that "less than 50 years old' and 'over 3 h in operative duration' were significantly high. Conclusion: This study suggests that 'less than 50 years' old and 'over 3 h in operative duration' were risk factors of postlaparoscopic SP. To protect from SP after laparoscopy, some countermeasures should be necessary especially for these patients.

Incidence and risk factors for acute shoulder pain after hepatectomy: a nested case-control study

“…However, the effect of age on shoulder pain remains controversial. Wada et al reported that younger age was a risk factor for gynecological laparoscopy [ 8 ]. By contrast, Nutchanart et al found that age was not associated with the incidence of shoulder pain after thoracic surgery [ 9 ].…”

Sodium Bicarbonate Sub-Diaphragmatic Irrigation Relieves Shoulder Pain After Total Laparoscopic Hysterectomy: A Randomized Controlled Trial

“…First of all, we did not analyze the sub-population of age and duration of operative time, which had been reported as the risk factors of PLSP. 34 Secondly, TLH related perineal pain be not included in the present study despite of causing discomfort to patients to some extent. Furthermore, the sample size was still small, although the number had been calculated in a statistical manner.…”

Effects of Intraperitoneal Bupivacaine Injection in Laparoscopic Appendectomy in Children on Postoperative Pain: A Controlled Randomized Double Blinded Study

“…SP rates among two groups were statistically significant at 12 th and 24 th h (p=0.03 and 0.04, respectively) although no difference was observed at first and 6 th h. Even though the PS were similar at 1 st h, late difference in SP rate may be indicating a possible benefit of subdiaphragmatic injection, which was not mentioned in the study of Hamill et al[ 18 ] Reducing SP which has already been accepted as a pitfall of laparoscopic surgery may lead better mobilization, increased quality of life and quicker recovery period in these children. [ 20 ] It has been shown that carbon dioxide irritates the abdominal and diaphragmatic nerves chemically and the mechanical effect of residual gas (also calling visceral ligament traction) is effective in the development of SP. [ 21 , 22 ] Various approaches have been presented in the literature to prevent or reduce SP after laparoscopic surgery.…”