Incidence of shoulder tip pain in patients with laparoscopic cholecystectomy

Abstract EN

Background : Laparoscopic cholecystectomy (LC) is the gold standard procedure for the surgical treatment of gallbladder disease; it is associated with decrease in postoperative pain and early mobilization after surgery, but still associated with shoulder tip pain that lead to patient’s distress and delayed discharge, so the provision of postoperative pain relief is of great importance.

Objectives : To evaluate the effect of intraperitoneal installation of local anesthesia (bupivacaine) on reduction of the incidence of shoulder tip pain after LC and its effect on postoperative analgesia need, early mobilization, and time of hospitalization.

Materials and Methods: An experimental double-blind randomized control trail study include 60 patients with elective laparoscopic cholecystectomy at the age between 18 and 60 years of both sex, randomly assigned to 30 patients in each group either Group A (not received bupivacaine) or Group B (intraperitoneal installation of bupivacaine), at the end of surgery after gallblader resection, 20 ml of 0.5% bupivacaine in 500 ml normal saline irrigate intraperitonealy.

Postoperatively, the patients were assessed for shoulder tip pain using visual analog scale, the number of analgesic doses required, and time of mobilization after surgery at 1hr, 4 hr, 8hr, and 12 hr postoperatively, and time of discharge was also recorded.

These information were analyzed using SPSS version 22.

Results: The visual analog scale was significantly higher in Group A compared to Group B at 1st, 4th, and 8th postoperative h (P = 0.0001, 0.0001, 0.001; P < 0.05), the total number of patients require rescue analgesia was higher in Group A than Group B, the mobilization after surgery in Group B earlier than Group A and shorter hospitalization in Group B than Group A.

Conclusion : Intraperitoneal instillation of bupivacaine (20 ml of 0.5%) with normal saline will significantly lower the intensity of postoperative shoulder tip pain, as well as decrease analgesic consumption, time to mobilize after surgery and time of hospitalization.