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Abstract Background: Laparoscopic cholecystectomy (LC) has become the standard treatment for gall bladder disease. However, despite its low degree of invasiveness, many patients complain of postoperative pain and postoperative nausea/vomiting. This study was planned to evaluate different factors affecting the incidence and severity of postoperative shoulder-tip pain after LC. Patients and Methods: One hundred consecutive patients who were treated for gall bladder stone by LC at the Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt, during the period from October 2008 to January 2010, were randomized according to different pnemoperitonum pressures (8, 10, 12, and 14 mm Hg). Each group comprises 25 patients. Results: There were 62 patients reported to have postoperative shoulder-tip pain during the first 12 hours after operation, which decreased to 9 patients on the 10th postoperative day. A significant difference was observed in the prevalence of pain at different pressures, 11% with low pressure and increased to 20% with high pressure. The incidence of shoulder-tip pain was significantly more in patients with a longer duration of the operation of >45 minutes at 12 hours (23 [76.7%] versus 39 [55.7%]; P = 0.04), at 24 hours (23 [76.7%] versus 29 [41.4%]; P = 0.009), and at 3 days postoperatively (19 [63.3%] versus 20 [28.6%]; P = 0.01). The volume of used gases during the operation had no effect on the incidence or severity of shoulder-tip pain after LC. Also, the use of intraoperative analgesics had no effect on the incidence or severity of shoulder-tip pain after LC. Conclusions: The origin of pain after LC is multifactorial. We recommend the use of the lower pressure technique during LC, and as patients with and without drains have similar incidence of postoperative shoulder pain, drains should not be used with the intention of preventing shoulder pain.
1 Faculty of Medicine, Gastroenterology Surgical Center, Mansoura University , Mansoura, Egypt .
This article was published in the following journal.
Name: Journal of laparoendoscopic & advanced surgical techniques. Part A
To evaluate postoperative pain in patients submitted to conventional laparoscopic cholecystectomy with four ports versus single-port laparoscopic cholecystectomy with only one port.
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Excision of the gallbladder through an abdominal incision using a laparoscope.
Unilateral or bilateral pain of the shoulder. It is often caused by physical activities such as work or sports participation, but may also be pathologic in origin.
Rapidly destructive shoulder joint and bone disease found mainly in elderly, and predominantly in women. It is characterized by SHOULDER PAIN; JOINT INSTABILITY; and the presence of crystalline CALCIUM PHOSPHATES in the SYNOVIAL FLUID. It is associated with ROTATOR CUFF INJURIES.
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