Iraqi Journal of Medical Sciences

Vol. 9 Issue 1 January - March / 2011
Published on website | Date : 2016-04-20 09:39:01

Does Post‐laparoscopic Cholecystectomy Intra‐abdominal Drain Reduces Postoperative Shoulder Pain?

Hassan A. Hassan, Anees K. Nile, Ahmed H. Ismael


Background: In the context of the much-heralded advantages of laparoscopic surgery, it can be easy to overlook post-laparoscopy pain as a serious problem, yet as many as 80% of patients will require opioid analgesia. It is generally accepted that pain after laparoscopy is multifactorial, and the surgeon is in a unique position to influence many of the putative causes by relatively minor changes in technique.
Objective: To determine whether a drain placed in the peritoneal cavity during laparoscopy is both clinical and cost-effective method of reducing postoperative shoulder pain.
Methods: One hundred female patients were having laparoscopic cholecystectomy were divided into two groups, a control group (50 patients) where no intra-peritoneal drain was inserted and second group (50 patients) in which the patients had intra-peritoneal gas drain sited in the subhepatic area. Patients' age, weight, height, operative time, total amount of CO2 and amount of analgesia used were recorded for each patient in both groups. Shoulder pain was assessed using visual analogue score (VAS) from 1-5 scale at 4, 8, 24 & 48 hours postoperatively, where as abdominal pain was assessed at 48 hour post-operatively. pH of the abdominal fluid was assessed in the second group of patients by using pH meter 48 hours postoperatively.
Results:Shoulder pain may occur in many of patients of the control group more frequent than those of the second group, where as postoperative abdominal pain was found to be greater in patients with subhepatic drain after laparoscopic cholecystectomy.
Conclusion: Low-cost drain decreased the frequency of shoulder pain and reduced the need for analgesia, but increases the abdominal pain; however it is less cost-effective than simple oral analgesia after laparoscopy.
Keywords: laparoscopic cholecystectomy, intra-abdominal drain, shoulder pain