Does post‐laparoscopy pain relate to residual carbon dioxide?

Abstract

Forum 485Although we have demonstrated statistically significant differences in both blood loss and contraction of the uterus between the syntocinon and saline groups, we d o not think that this difference is clinically significant since the amount of blood loss was quite small. Syntocinon is not devoid of side effects when given as a bolus intravenous injection; it causes vasodilatation with transient hypotension and reflex tachycardia, which may be tolerated well in young healthy women, but may be hazardous in patients with a compromised circulation resulting from hypovolaemia, valvular stenosis or other causes of fixed cardiac output. We conclude therefore that syntocinon should not be given routinely during vaginal termination of pregnancy. References SummaryWe studied 20 dajl case gynaecological laparoscopy patients, who had an erect chest X ray taken before discharge. Patients were telephoned the next duy ,for a semi-structured interview. Particular note was made of shoulder tip pain and pain relieoed by changing posture. The X ra-v was analysed for measurements of the length of arc and height of the gas bubble under each hemi-diaphragm, ,from which an estimation of bubble volume was also made. We found statistically signijcant correlations between both the length of arc @ = 0.005) and volume of gas bubble @ = 0.008) on the right side, with the pain score. Residual gas can be a prominent cause ofpost-laparoscopy pain.

Effect of multimodal analgesia in laparoscopic colecistectomy in outpatient regime

“…El dolor postcolecistectomía en la cirugía laparoscópica parece estar provocado por el neumoperitoneo, por lo que se recomienda trabajar a bajas presiones de CO2, así como la completa expulsión del gas antes de cerrar los orificios de los trócares (13,14,15).…”

Techniques to reduce shoulder pain after laparoscopic surgery for benign gynaecological disease: a systematic review

“…It is thought that pneumoperitoneum causes diaphragmatic irritation by overstretching the diaphragmatic muscle fibres resulting in a pain sensation mediated by the phrenic nerve [23]. Jackson et al investigated the association between the dimension of the gas bubbles in the peritoneal cavity and the severity of pain and found a correlation between the residual gas volume and post-laparoscopic pain [23]. To support the theory of overstretched diaphragmatic muscle fibres, it has also been shown that low insufflation rate reduces post-operative SP [24].…”

A Study to Evaluate Role of Intraperitoneal Saline Wash for Shoulder Tip Pain Reduction after Laparoscopic Cholecystectomy

“…As far shoulder pain in laparoscopic procedure though precise reason is unclear, but leading hypothesis is that CO 2 introduced in abdomen cause phrenic nerve irritation causing referred pain to C4 segment [8]. Prolonged presence of shoulder tip pain suggests excitation of phrenic nerve [9].…”