Does Irrigation of the Subdiaphragmatic Region with Ropivacaine Reduce the Incidence of Right Shoulder Tip Pain after Laparoscopic Cholecystectomy? A Prospective Randomized, Double-blind, Controlled Study

Niknam, Farshid; Saxena, Akshat; Niles, Navindran; Budak, Ulvi U; Mekisic, Allan

doi:10.1177/000313481408000112

Cited by 9 publications

(4 citation statements)

References 2 publications

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“…The effect of incisional local anaesthesia (LA) was examined in four RCTs, 78 , 79 , 80 , 81 which did not lead to a reduction in LOS compared with placebo (p = 0.200). The effect of intraperitoneal LA was examined in 12 studies, 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 which demonstrated no change in LOS (p = 0.200) or day case rates (p = 0.110). A total of five studies 81 , 93 , 94 , 95 , 96 were found examining the effect of combined intraperitoneal and incisional LA and this likewise did not show a significant reduction (p = 0.060).…”

Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of factors which reduce the length of stay associated with elective laparoscopic cholecystectomy

Ryan

OʼConnell

Rogers

et al. 2021

HPB

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Background Laparoscopic cholecystectomy is a safe ambulatory procedure in appropriately selected patients; however, day case rates remain low. The objective of this systematic review and meta-analysis was to identify interventions which are effective in reducing the length of stay (LOS) or improving the day case rate for elective laparoscopic cholecystectomy. Methods Comparative English-language studies describing perioperative interventions applicable to elective laparoscopic cholecystectomy in adult patients and their impact on LOS or day case rate were included. Results Quantitative data were available for meta-analysis from 80 studies of 10,615 patients. There were an additional 17 studies included for systematic review. The included studies evaluated 14 peri-operative interventions. Implementation of a formal day case care pathway was associated with a significantly shorter LOS (MD = 24.9 h, 95% CI, 18.7–31.2, p < 0.001) and an improved day case rate (OR = 3.5; 95% CI, 1.5–8.1, p = 0.005). Use of non-steroidal anti-inflammatories, dexamethasone and prophylactic antibiotics were associated with smaller reductions in LOS. Conclusion Care pathway implementation demonstrated a significant impact on LOS and day case rates. A limited effect was noted for smaller independent interventions. In order to achieve optimal day case targets, a greater understanding of the effective elements of a care pathway and local barriers to implementation is required.

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Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of factors which reduce the length of stay associated with elective laparoscopic cholecystectomy

Ryan

OʼConnell

Rogers

et al. 2021

HPB

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“…Cuniffe et al [16] showed that intraperitoneal irrigation with bupivacaine to both hemidiaphragms at the end of surgery, without additional difficulty or significant extra operating time, proved to be a reliable method in reducing frequency and intensity shoulder tip pain, with a great potential to reduce patient morbidity. Ropivacaine, administered in a similar fashion was ineffective in reducing shoulder tip pain [80]. Local anesthetic distribution may not always be uniform throughout the peritoneal surface.…”

Section: Bupivacaine and Ropivacaine Irrigationmentioning

confidence: 97%

“…NSAIDs are often used during surgery and in the post-operatory period, with analgesic properties comparable to those of opioid compounds, but without opioid-related side-effects [78]. They are considered an established therapy in reducing shoulder pain [68,79,80], but sometimes with conflicting results [81].…”

Section: Drain Insertionmentioning

confidence: 99%

Omalgia in Laparoscopic Kidney Surgery

Gaspar¹,

Dias²,

Lopes³

2014

Med Surg Urol

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Minimal invasive surgery has well-known advantages. The majority of procedures performed on the kidney are now-a-days laparoscopic, with several advantages over laparotomy: decreased perioperative morbidity and mortality, smaller incisions, faster recovery, shorter hospital stays and earlier return to active life. Postoperative pain is the most common complaint and an important issue following laparoscopic surgery. There are different theories proposed to explain omalgia: distension of the peritoneal blood vessels and nerves during pneumoperitoneum, the associated inflammatory reaction (release of proinflammatory cytokines), rate of CO 2 infusion; distension of the triangular and round ligament; time of exposure to the gas; gas retention inducing irritation of the phrenic nerve; nerve injury during patient positioning (shoulder abduction) and diaphragm injury. Debate still exists on how to minimize it. We review the different etiologic mechanisms and proven and potential preventive measures and treatments on how to avoid postoperatory pain: proper patient positioning, pulmonary recruitment maneuvers, intraperitoneal normal saline infusion, using gabapentin, pregabalin, irrigation with bupivacaine, using NSAIDs, opioids and hydrocortisone.

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“…For instance, post-endoscopic shoulder pain frequently follows a laparoscopic cholecystectomy 5 . A proposed mechanism is the transient injury of the phrenic nerve (PN) by CO 2 during peritoneal insufflation 6 . The incidence of such pain varies from 35–50%, and in some cases, the pain has been reported to last longer than 72 hours 5–7 .…”

Section: Introductionmentioning

confidence: 99%

Animal Study to Evaluate the Effect of Carbon Dioxide Insufflation on Recurrent Laryngeal Nerve Function in Transoral Endoscopic Thyroidectomy

Zhang

Dionigi

et al. 2019

Sci Rep

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Data with regard to potential recurrent laryngeal nerve (RLN) compromise caused by intra-neck CO 2 insufflation during transoral endoscopic thyroidectomy vestibular approach (TOETVA) are missing. RLN electromyographic (EMG) profiles, metabolic and hemodynamic parameters (oxygen saturation, heart rate, blood pressure, experimental time, CO 2 partial pressure, pH, O 2 partial pressure), central venous pressure (CVP), airpocket temperature and pressure were recorded in a TOETVA animal model. Twelve pigs were randomly divided into different groups according to increasing CO 2 insufflation pressures. Nerves segments were then collected for histopathology. Significant variation of metabolic and hemodynamic parameters were registered when CO 2 insufflation pressures increased x3 and x5 the baseline parameters. Combined EMG amplitude drop and latency increase also were documented. There was no significant change in the intraluminal temperature. RLNs structure were preserved with normal axons, no fibrosis, and no vacuolization and without loss of myelinated fibers during the experiment. RLN EMG profiles (but not histology) were altered when CO 2 insufflation pressures increased.

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Does Irrigation of the Subdiaphragmatic Region with Ropivacaine Reduce the Incidence of Right Shoulder Tip Pain after Laparoscopic Cholecystectomy? A Prospective Randomized, Double-blind, Controlled Study

Cited by 9 publications

References 2 publications

Systematic review and meta-analysis of factors which reduce the length of stay associated with elective laparoscopic cholecystectomy

Systematic review and meta-analysis of factors which reduce the length of stay associated with elective laparoscopic cholecystectomy

Omalgia in Laparoscopic Kidney Surgery

Animal Study to Evaluate the Effect of Carbon Dioxide Insufflation on Recurrent Laryngeal Nerve Function in Transoral Endoscopic Thyroidectomy

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