Shoulder Tip Pain Following Laparoscopic Cholecystectomy-a Randomized Control Study to Determine the Cause

The aim of this study was to determine the effect of low-pressure pneumoperitoneum and duration of surgery in laparoscopic cholecystectomy on postoperative shoulder tip pain. A total of 100 patients were assigned into two groups depending on the intraperitoneal pressure during laparoscopic cholecystectomy. Group A included patients in whom the intraperitoneal pressure was 13-15 mm of Hg and group B included patients who underwent surgery at 10-12 mmHg. Each group was then subdivided into two subgroups depending on the duration of surgery. In the first subgroup, the duration of surgery was less than 1 h and the next subgroup included patients who took more than 1 h. Presence or absence of shoulder tip pain was recorded within 4 h, at 24 h, and at 48 h. Total number of patients having shoulder tip pain in the lower pneumoperitoneal group was more than the higher pneumoperitoneal group in both subgroups, P values >0.05. More patients in the <1 h subgroup had shoulder tip pain as compared to the >1 h group at both pneumoperitoneal groups, P values >0.05. Shoulder tip pain was most at 24 h and gradually decreased thereafter. In our study, intra-abdominal pressures and shorter duration of surgery were factors unrelated to incidence of shoulder tip pain after laparoscopic cholecystectomy.