Shoulder pain following laparoscopic cholecystectomy: factors affecting the incidence and severity

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.

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.

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.

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.