Omalgia in Laparoscopic Kidney Surgery

Abstract

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.