To drain or not to drain: the association between residual intraperitoneal gas and post-laparoscopic shoulder pain for laparoscopic cholecystectomy

Abstract

Residual intra-peritoneal gas may be associated with post-laparoscopic shoulder pain (PLSP), which is a frequently and disturbance compliant after surgery. Herein, we aimed to examine whether expiring residual gas via a surgical drain reduces the frequency and intensity of PLSP in the first day after laparoscopic cholecystectomy. 448 participants were enrolled in this prospective cohort study. The incidence and severity of PLSP after surgery were recorded. Of these, the cumulative incidence of PLSP in the drain group was lower particularly at the 12th postoperative hour (18.3% vs. 27.6%; P = 0.022), 24th postoperative hour (28.8% vs. 38.1%; P = 0.039), and throughout the first postoperative day (P = 0.035). The drain group had less severe PLSP (crude Odds ratio, 0.66; P = .036). After adjustment using inverse probability of treatment weighting, the drain group also had a significant lower PLSP incidence (adjusted hazard ratio = 0.61, P < 0.001), and less severe PLSP (adjusted odds ratio = 0.56, P < 0.001). In conclusion, the maneuver about passive force to expel residual gas, surgical drain use, contributes to reduce the incidence and severity of PLSP, suggesting that to minimize residual gas at the end of surgery is useful to attenuate PLSP.

Determining a Method to Minimize Pain After Laparoscopic Cholecystectomy Surgery

“…This suggests that minimizing residual gas at the end of surgery is beneficial for reducing postlaparoscopic shoulder pain. 27 Our study also revealed results consistent with studies.…”

“…Therefore, a clear conclusion that postoperative drainage reduces pain following LC is not definitive. El-Labban et al26 also stated the necessity to use a drain 27…”

“…El-Labban et al 26 also stated the necessity use a drain. 27 Passive force maneuvering to expel residual gas and the use of surgical drainage contribute to reducing the incidence and severity of postlaparoscopic shoulder pain. This suggests that minimizing residual gas at the end of surgery is beneficial for reducing postlaparoscopic shoulder pain.…”

Patients with low body mass index are more likely to develop shoulder pain after laparoscopy

“…However, laparoscopic surgery can also induce postoperative shoulder pain, vascular injury, intestinal injury, urinary tract injury, air embolism, and other related complications. Among these complications, post‐laparoscopic shoulder pain is one of the most common complications of laparoscopic surgery, with an incidence rate of 34.1%–82.4% 1,2 …”

The Effect of Dexamethasone on Postoperative Pain in Patients After Laparoscopic Cholecystectomy

“…Medical practitioners have advised and used various techniques to minimize this, like preoperative administration of opioids or opioid-sparring analgesia, clonidine, preoperative pregabalin, wound site instillation of local anesthetics, and intraperitoneal irrigation with bupivacaine or ondansetron and suctioning of residual gas from the peritoneum before closure [3][4][5][6][7][8][9][10]. 1 2…”