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Effect of fluid instillation on postlaparoscopy pain
1AMI Brookwood Women's Medical Center, Birmingham, Alabama 35209.
The Journal of Reproductive Medicine
|October 1, 1993
Summary
Instilling fluid after laparoscopy significantly reduces postoperative pain. This simple technique decreases subdiaphragmatic and shoulder discomfort when sitting or standing.
Area of Science:
- Surgical Innovation
- Pain Management
- Minimally Invasive Surgery
Background:
- Postoperative pain, particularly postural pain, is a common complication following operative laparoscopy.
- The exact mechanisms causing this pain, often felt in the subdiaphragmatic and shoulder regions, are not fully understood.
- Current management strategies for laparoscopic pain are varied and their efficacy is debated.
Purpose of the Study:
- To evaluate the effect of fluid instillation at the end of operative laparoscopy on postoperative postural pain.
- To investigate potential correlations between pain intensity and factors such as operative time, closing pH, and surgeon in the initial phase.
- To compare the incidence of postural pain in patients receiving postoperative fluid instillation versus a control group in the second phase.
Main Methods:
- A randomized, double-blind study involving 137 patients undergoing operative laparoscopy.
- Phase 1: Analysis of pain intensity related to closing pH, operative time, and surgeon.
- Phase 2: Comparison of postural pain between a fluid instillation group and a control group.
Main Results:
- No significant relationship was found between pain intensity and operative duration, closing pH, or surgeon in Phase 1.
- In Phase 2, only 22% of patients receiving fluid instillation reported postural pain, compared to 76% in the control group (P < .001).
- Fluid instillation significantly reduced the frequency of subdiaphragmatic and shoulder pain upon sitting or standing.
Conclusions:
- Instillation of 1-2 L of fluid at the conclusion of laparoscopy effectively displaces pneumoperitoneum and significantly decreases postoperative postural pain.
- The reduction in pain is likely due to preventing traction on the liver's supporting ligaments, which is caused by the loss of the diaphragm's suction effect.
- This technique offers a promising, simple, and effective method for managing a common source of postoperative discomfort after laparoscopic procedures.