Shoulder-Tip Pain After Laparoscopic Surgery: A Narrative Review of Intraperitoneal Anaesthesia

Shoulder-tip pain is a common and distressing side effect following laparoscopic surgery. Standard systemic analgesic regimens are used to manage postoperative pain but are often associated with side effects such as nausea and vomiting. There is some evidence to support a reduction in insufflation pressure to lessen shoulder-tip pain. This narrative review examined the efficacy of intraperitoneal anaesthesia on shoulder-tip and overall pain after laparoscopic surgery.

Relevant literature was identified through database searches containing terms related to intraperitoneal anaesthesia, insufflation pressure, laparoscopic surgery, shoulder-tip pain and postoperative pain.

Most studies evaluating intraperitoneal local anaesthesia used bupivacaine or ropivacaine. There was a wide variety of surgical procedures with limited reporting of shoulder-tip pain. Mixed results were found regarding the efficacy of intraperitoneal anaesthesia on total pain scores.

Intraperitoneal anaesthesia may be an effective strategy to reduce postoperative shoulder-tip and overall pain scores following laparoscopic surgery, but the evidence remains inconclusive due to methodological heterogeneity. Further well-designed studies, particularly in upper gastrointestinal laparoscopic surgery, using standardised dosing of intraperitoneal anaesthesia, standard versus low insufflation pressure, and validated outcome measures are required to determine its clinical efficacy.