Das postpelviskopische-(laparoskopische) Schmerzsyndrom

Abstract

Following laparoscopy 18.5% of 200 patients had sub-phrenic pain on the day of operation and 28% had shoulder pain. During the night following the operation or on the first post-operative day 30.5% of the 200 patients had sub-phrenic pain and 54.5% had shoulder pain. A total of 63% of the patients had shoulder pain and 37.5% of the patients had sub-phrenic pain. 31.5% of the patients had a combination of both types of pain. Most of the sub-diaphragmatic pain was on the right side. In 93% of all patients the post-operative radiological investigation of the chest showed subphrenic gas. The remaining gas was aspirated and measured by infrared spectroscopy. All the remaining gas was carbon dioxide. The previously suggested absorption rates for carbon dioxide are probably too high. The transition of anaesthetic gas (e.g. N2O) through the peritoneum into the abdominal cavity as suggested by Hodgson, McClelland, and Newton was not detected in these measurements. The most likely cause of the post-laparoscopic pain syndrome is the effect of the volume of the remaining gas of the phrenic nerve.

Qualitätsmanagement der postoperativen Schmerztherapie

“…Entgegen bisherigen Publikationen [5,12] verursachten in unserem Patientengut laparoskopische Appendektomien und Sigmaresektionen signifikant höhere Schmerzen als die entsprechenden konventionellen Therapieverfahren. Verantwortlich hierfür könnten bei den laparoskopisch operierten Patienten das "postlaparoskopische Schmerzsyndrom" sein mit zusätz-lichen Schmerzlokalisationen an Trokareinstichstellen, der Schulter und subphrenisch [10,12] oder ein Unterschätzen der Schmerzen nach laparoskopischen Eingriffen. Deshalb wird künftig besonders nach laparoskopischen bzw.…”

Exposure of the operative field in laparoscopic surgery

“…Indeed, nitrogen is insoluble in water as well as chemically, and there is some danger of air embolism. Gas remaining in the abdominal cavity will not be absorbed and it is radiologically visible, as a subphrenic sickle, with the patients having typical complaints [22].…”

POstLAparoscopic Reduction of pain By combining intraperitoneal normal salinE And the pulmonary Recruitment maneuver (POLAR BEAR trial). RCT to estimate reduction in pain after laparoscopic surgery when using a combination therapy of intraperitoneal normal saline and the pulmonary recruitment maneuver

“…Despite these advantages, many patients suffer from pain in the shoulder and upper abdomen after laparoscopy. The incidence of shoulder pain ranges from 35 to 80% [2–8]. …”

“…This may result in an irritative effect on the peritoneum and diaphragm [10, 12–15]. Furthermore, post-laparoscopic pain is thought to be caused by retention of carbon dioxide in the abdomen, which irritates the phrenic nerve and diaphragm and causes referred pain in the shoulder and pain in the upper abdomen [2, 9, 10, 16]. A significant correlation between the amount of residual pneumoperitoneum and pain scores has been reported [2, 9, 16].…”

“…Furthermore, post-laparoscopic pain is thought to be caused by retention of carbon dioxide in the abdomen, which irritates the phrenic nerve and diaphragm and causes referred pain in the shoulder and pain in the upper abdomen [2, 9, 10, 16]. A significant correlation between the amount of residual pneumoperitoneum and pain scores has been reported [2, 9, 16]. It is not clear whether the length of the surgical procedure has an effect on the intensity or incidence of post-laparoscopic pain [17, 18].…”