Shoulder Tip Pain Following Laparoscopic Cholecystectomy—a Randomized Control Study to Determine the Cause

Dey, Ashish; Malik, Vinod

doi:10.1007/s12262-013-0849-9

Cited by 22 publications

(15 citation statements)

References 15 publications

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“…26 Dey et al evaluated persistence of preoperative symptoms at 6 months after the LC and found them to be present in 8.6% of patients. 27 In present study, preoperative symptoms rate was found to be 9.1% at 3 months interval, probably owing to the fact that the patients in present study had a much favourable physical and biochemical profile. The time of observation is a key factor for calculating PCS rates which are quite high in early post-operative period.…”

Section: Discussionmentioning

confidence: 40%

Pre-operative predictors of difficult laparoscopic cholecystectomy and its correlation with post-cholecystectomy syndrome and its impact on quality of life in North Indian population

et al. 2021

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Background: Laparoscopic cholecystectomy (LC) is the most preferable surgical procedure worldwide. LC is not completely risk-free and 2 to 15% of attempted LC procedures have to be converted to open cholecystectomy. The aim of the study was to assess the predictors of difficult LC procedures and for knowing the impact of difficult LC procedures on post-cholecystectomy syndrome and quality of life of patients.Methods: A prospective observational study was conducted on patients who underwent LC. Clinical, demographic, radiological and biochemical parameters along with detailed history of patients were documented. Laparoscopic cholecystectomy was then done on patients using standard technique. Level of difficulty in LC procedure was assessed and graded. Occurrence of post-cholecystectomy syndrome was investigated and quality of patient’s life was assessed using SF-36 inventory.Results: The difficulty rate in LC procedure was observed to be 17.4%. The clinical predictors of difficult LC procedures were old age and prior history of abdominal surgery. Contracted gall bladder, peripancreatic fluid and thick gallbladder wall were radiological predictors and presence of adhesions, longer duration of surgery and conversion to open procedures were intraoperative predictors of difficult LC procedures. Early PCS was affected by difficult LC procedures; though with passage of time it reduced. Post-operative quality of life was affected more by PCS incidence than the difficult LC procedure.Conclusions: The findings of the study would help in anticipating predictors of difficult LC procedures and in understanding the phenomenology and determinants of PCS along with its relationship with operative difficulty and quality of life of patients.

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Section: Discussionmentioning

confidence: 40%

Pre-operative predictors of difficult laparoscopic cholecystectomy and its correlation with post-cholecystectomy syndrome and its impact on quality of life in North Indian population

et al. 2021

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“…Although we observed higher surgeon's satisfaction score in LPCP group in terms of exposure and working space, it was insignificant and except one in LPCP group there was no conversion to high pressure and no intraoperative complications were seen in any group. 16,17 In…”

Section: Discussionmentioning

confidence: 99%

Comparative Study of Low Pressure versus Standard Pressure Carbon Dioxide Pneumoperitoneum in Reducing Shoulder Tip Pain Post Laparoscopic Cholecystectomy

Thapa¹,

Thapa²,

Sharma³

2022

J. Nepalgunj Med. College

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Introduction: Laparoscopic cholecystectomy is the gold standard treatment for cholelithiasis. Postoperative shoulder tip pain is common complaint. Evidences suggest that using low pressure pneumoperitoneum (8-10 mmHg) during the procedure rather than standard pressure (12-14 mmHg) decreases the incidence and severity of shoulder tip pain without compromising working space. Aims: The aim of this study was to evaluate the impact of low pressure and standard pressure pneumoperitoneum on shoulder tip pain post laparoscopic cholecystectomy. Methods: A prospective hospital based study conducted at Nepalgunj Medical College, Kohalpur from January 2019 to December 2020. Hundred patients were enrolled, fifty each in “low pressure carbondioxide pneumoperitoneum” and “standard pressure carbondioxide pneumoperitoneum” groups, who underwent laparoscopic cholecystectomy. The two groups were compared in terms of incidence and severity of shoulder tip pain, surgeon’s satisfaction score, top-up analgesia requirement, procedural time, conversion to standard pressure, intraoperative complications and length of hospital stay. Results: There were 45 (90%) females and five (10%) males in low pressure group and 44 (88%) females and six (12%) males in standard pressure group. Fourteen (28%) patients in low pressure and 32 (64%) patients in standard pressure group had shoulder tip pain (p=0.001). The severity of shoulder tip pain was less in low pressure group and was significant at eight hours (p=0.006) and 12 hours (p=0.008). Top-up analgesia was required more in standard pressure group. There were no intraoperative complications but only one conversion to standard pressure. Surgeon’s satisfaction score, conversion to open cholecystectomy and procedural time were comparable in both groups with shorter hospital stay in low pressure group. Conclusion: Low pressure carbondioxide pneumoperitoneum is safe and effective strategy in reducing incidence and severity of shoulder tip pain after laparoscopic cholecystectomy.

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“…Ameliyatlar farklı cerrahlar tarafından yapılmıştı ve çalışma kollarına dağılım GIRIŞ Laparoskopik kolesistektomi (LK), 1990'ların başından beri safra kesesi hastalıklarının cerrahi tedavisinde altın standart tedavi yöntemi olarak kabul edilmektedir (1). Laparoskopik kolesistektomiden sonraki ağrı paterni üç ayrı bileşenden oluşur: insizyonel ağrı (somatik ağrı), visseral ağrı (derin karın içi ağrı) ve omuz ağrısı (yansıyan somatik ağrı) (2).…”

Section: Gereç Ve Yöntemlerunclassified

Pain Management After Laparoscopic Cholecystectomy

Yaprak¹,

Doğru²,

Mescı³

et al. 2019

Akd Med J

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ÖZAmaç: Ağrı algısı sadece duyusal bir uyarıcı değil, aynı zamanda motivasyonel durum ve duygu durumu ile yakından ilgilidir ve kültürel öğrenme, geçmiş deneyimler, kaygı ve depresyon ile şekillenir. Çalışmada laparoskopik kolesistektomi için uygulanan postoperatif analjezi protokollerindeki opioid tüketimini azaltabilecek yardımcı ajanları belirlemek amaçlanmıştır. Gereç ve Yöntemler:Nonsteroidal antienflamatuar bir ilaç olan Dexketoprofen ve zayıf bir opioid olan Tramadol'u içeren standart bir postoperatif yatan hasta ağrı yönetimi protokolü alan hastalarımız içinde bir anksiyolitik olan Alprazolam'ın preoperatif uygulanmasının (n=12) opioid ihtiyacı üzerine etkisi istatistiksel analizlerle incelendi . Kontrol grubu (n=81), sadece standart protokole bağlı kalanları içermekteydi. Lokal anestezik Bupivakainʼin adjuvan kullanımı, kesi yerine infiltrasyonu (n=23) ile opioid ihtiyacı arasındaki ilişki ayrıca analiz edildi.Bulgular: Ameliyat öncesi Alprazolam verilen ve kesi yerlerine Bupivakain Hidroklorür enjeksiyonu yapılan grupların ilk 24 saatlik opioid gereksinimi kontrol grubuna göre anlamlı derecede düşüktü (sırasıyla p=0,019 ve p=0,033). Toplam opioid tüketimi, sadece lokal anestezi grubunda kontrol grubuna göre anlamlı derecede düşüktü (p=0,045). Alprazolam grubunda, kontrol grubuna göre ilk 24 saatten sonra opioid talep etme riskinin önemli ölçüde arttığı gözlendi. Odds ratio 4,0 (%95 Cl, 1,00 ila 15,99; p=0,038) idi.Sonuç: Bupivakain, Alprazolam ve Tramadol, P450 sisteminin aynı alt birimi ile metabolize edilir; CYP3A4 enzimi. Bu nedenle, bu ilaçların eliminasyonu sırasında enzim için yarışma gerçekleşip vücutta bu duruma bağlı ilaç toksisiteleri gelişebilir. Öyle ki, çalışmada preoperatif Alprazolam alan hastalarda ameliyat sonrası ilk günden sonra Tramadol HCl için artmış ilaç arama davranışı gözlemlenmiştir. Bu durum opioid toksisitesi riski için anlamlı bir ipucu olarak değerlendirilebilir. ABSTRACTObjective: The perception of pain is not only a sensorial stimulus, but it is closely related with motivational state and affect and it is shaped with cultural learning, past experiences, anxiety and depression. Common postoperative analgesia protocols for laparoscopic cholecystectomy are scrutinized to identify adjunctive agents reducing weak opioid consumption. Material and Methods:Preoperative administration of an anxiolytic, Alprazolam (n=12), was analyzed among patients who received a standardized postoperative inpatient pain management protocol including a nonsteroidal anti-inflammatory drug, Dexketoprofen, and a weak opioid, Tramadol. The control group (n=81) included those who adhered to the standardized protocol only. Adjunctive use of the local anesthetic Bupivacaine, by means of wound infiltration (n=23) was analyzed separately to compare the analgesic outcome.

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Shoulder Tip Pain Following Laparoscopic Cholecystectomy—a Randomized Control Study to Determine the Cause

Cited by 22 publications

References 15 publications

Pre-operative predictors of difficult laparoscopic cholecystectomy and its correlation with post-cholecystectomy syndrome and its impact on quality of life in North Indian population

Pre-operative predictors of difficult laparoscopic cholecystectomy and its correlation with post-cholecystectomy syndrome and its impact on quality of life in North Indian population

Comparative Study of Low Pressure versus Standard Pressure Carbon Dioxide Pneumoperitoneum in Reducing Shoulder Tip Pain Post Laparoscopic Cholecystectomy

Pain Management After Laparoscopic Cholecystectomy

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