About
The Journal "Obstetrics and Gynecology"Journal HistoryAims and ScopePolicies on Conflict of Interest, Human and Animal Rights, and Informed ConsentEditorial ProcessData sharing statementAdvertising PolicyThe Process for Handling Cases Requiring Corrections, Retractions, and Editorial Expressions of ConcernEditorial BoardEditorial CounsilInformation for ProfessionalsNewsContacts
ArchiveEthical StandardsSubscription
For authors
InstructionsInformed consent policyContract offerEASE GuidelinesICJME CriteriaWAME Recommendations on ChatGPT and Chatbots in Relation to Scholarly Publications
Reviewing
About
The Journal "Obstetrics and Gynecology"Journal HistoryAims and ScopePolicies on Conflict of Interest, Human and Animal Rights, and Informed ConsentEditorial ProcessData sharing statementAdvertising PolicyThe Process for Handling Cases Requiring Corrections, Retractions, and Editorial Expressions of ConcernEditorial BoardEditorial CounsilInformation for ProfessionalsNewsContacts
ArchiveEthical StandardsSubscription
For authors
InstructionsInformed consent policyContract offerEASE GuidelinesICJME CriteriaWAME Recommendations on ChatGPT and Chatbots in Relation to Scholarly Publications
Reviewing
Logout
Obstetrics and Gynegology2023№9
Shoulder pain syndrome after laparoscopy:...

Shoulder pain syndrome after laparoscopy: epidemiology, pathogenesis, prevention methods

DOI
https://dx.doi.org/10.18565/aig.2023.145

Shapovalova E.A., Basos A.S., Shkarupa I.A., Glushchenko Zh.V., Тereshin S.M., Babina U.F., Savina A.A., Shiryaeva A.V.

1) Saint Petersburg State University Hospital, Saint Petersburg, Russia, Saint Petersburg, Russia; 2) Dzhanelidze Saint Petersburg Research Institute of Emergency Сare, Saint Petersburg, Russia; 3) Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia, Saint Petersburg, Russia
Laparoscopy is considered the gold standard for the surgical treatment of most pelvic diseases. Along with this, laparoscopic interventions are accompanied by the appearance of a specific postlaparoscopic shoulder pain (PLSP). During the first two days after surgery some patients can experience a severe pain which limits their mobilization. There is a global trend towards the introduction of protocols for enhanced recovery after surgery (ERAS) aimed at reducing the stress associated with the surgical intervention and the rapid return of patients to normal life. This article describes the epidemiology of postlaparoscopic shoulder pain. Its pathogenesis and the most common theories of its origin are reviewed. The results of the studies devoted to the methods of reducing postoperative pain syndrome in accordance with the suggested theories are presented in the article. There is a description of the effect of changing the gas for the pneumoperitoneum and reducing its pressure level, instillation of saline solution into the abdominal cavity, forced gas removal, as well as local use of anesthetics.
Conclusion: To date, this issue has not been sufficiently covered in the national literature, and the available data from foreign studies are contradictory. It is necessary to conduct the research on the frequency of postlaparoscopic pain syndrome and factors affecting its severity, as well as the search for effective and safe methods for its reduction.

Authors’ contributions: Shapovalova E.A. – developing the concept of the study, analysis and interpretation of the obtained data, writing and editing the text, approval of the final version of the article; Basos A.S., Shkarupa I.A., Glushchenko Zh.V. – developing the concept of the study, editing the text, approval of the final version of the article; Tereshin S.M., Babina U.F., Savina A.A., Shiryaeva A.V. – data collection and analysis, writing the text.
Conflicts of interest: The authors declare no possible conflicts of interest.
Funding: The study was conducted without sponsorship.
For citation: Shapovalova E.A., Basos A.S., Shkarupa I.A., Glushchenko Zh.V., Тereshin S.M., Babina U.F., Savina A.A., Shiryaeva A.V. Shoulder pain syndrome after laparoscopy: epidemiology, pathogenesis, prevention methods.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2023; (9): 44-51 (in Russian)
https://dx.doi.org/10.18565/aig.2023.145

Keywords

laparoscopy
shoulder pain after laparoscopy
PLSP
ERAS
postoperative pain syndrome
Full text (in Russian)

References

  1. Altman A.D., Helpman L., McGee J.,Samouëlian V., Auclair M.-H., Brar H. et al. Enhanced recovery after surgery: Implementing a new standard of surgical care. 2019; 191(17): E469-75. https://dx.doi.org/10.1503/cmaj.180635.
  2. Торубаров С.Ф., Духин А.О., Чмыр Е.Н. Fast track в гинекологии: реалии сегодняшнего дня. Акушерство и гинекология. 2019; 10: 60-5. [Torubarov S.F., Dukhin A.O., Chmur E.N. Fast track in gynecology: today’s realities. Obstetrics and Gynecology. 2019; (10): 60-5. (in Russian)].https://dx.doi.org/10.18565/aig.2019.10.60-65.
  3. Mouton W.G., Bessell J.R., Otten K.T., Maddern G.J. Pain after laparoscopy. Surg. Endosc. 1999; 13: 445-8. https://dx.doi.org/10.1007/s004649901011.
  4. Cason C.L., Seidel S.L., Bushmiaer M. Recovery from laparoscopic cholecystectomy procedures. AORN J. 1996; 63(6): 1099-103, 1106-8, 1111-2 passim. https://dx.doi.org/10.1016/s0001-2092(06)63296-1.
  5. Phelps P., Cakmakkaya O.S., Apfel C.C., Radke O.C. A simple clinical maneuver to reduce laparoscopy-induced shoulder pain: a randomized controlled trial. Obstet. Gynecol. 2008; 111(5): 1155-60. https://dx.doi.org/10.1097/AOG.0b013e31816e34b4.
  6. Фейдоров И.Ю., Нигматов М.М., Аскерханов Р.Г. Болевой синдром после традиционной лапароскопической холецистэктомии и холецистэктомии из единого трансумбиликального доступа. Эндоскопическая хирургия. 2016; 22(6): 41 4. [Feydorov I.Yu., Nigmatov M.M., Askerkhanov R.G. Pain syndrome after conventional laparoscopic cholecystectomy and single incision laparoscopic cholecystectomy. Endoscopic Surgery. 2016; 22(6): 41 4.(in Russian)]. https://dx.doi.org/10.17116/endoskop201622641-44.
  7. Sao C.-H., Chan-Tiopianco M., Chung K.-C., Chen Y.-J., Horng H.-C., Lee W.-L. et al. Pain after laparoscopic surgery: focus on shoulder-tip pain after gynecological laparoscopic surgery. J. Chin. Med. Assoc. 2019; 82(11): 819-826. https://dx.doi.org/10.1097/JCMA.0000000000000190.
  8. Adlan A.S.A., Azhary J.M.K., Tarmidzi H.Z.M., Kamarudin M., Lim R.C.S., Ng D.S.W. Post Laparoscopy Pain Reduction Project I (POLYPREP I): intraperitoneal normal saline instillation - a randomised controlled trial. BMC Womens Health. 2022; 12;22(1):116. https://dx.doi.org/10.1186/s12905-022-01696-z.
  9. Chang S.H., Lee H.W., Kim H.K., Kim S.H., Kim D.K. An evaluation of perioperative pregabalin for prevention and attenuation of postoperative shoulder pain after laparoscopic cholecystectomy. Anesth. Analg. 2009; 109(4):1284-6. https://dx.doi.org/10.1213/ane.0b013e3181b4874d.
  10. Riedel H.H., Semm K. The post-laparoscopic pain syndrome (author's syndrome). Geburtshilfe und Frauenheilkunde. 1980; 40(7): 635-43.https://dx.doi.org/10.1055/s-2008-1037224.
  11. Saccardi C., Gizzo S., Vitagliano A., Noventa M., Micaglio M., Parotto M. et al. Peri-incisional and intraperitoneal ropivacaine administration: a new effective tool in pain control after laparoscopic surgery in gynecology: a randomized controlled clinical trial. Surg. Endosc. 2016; 30(12): 5310-8.https://dx.doi.org/10.1007/s00464-016-4881-2.
  12. Tsai H.W., Chen Y.-J., Ho C.-M., Hseu S.-S., Chao K.-C., Tsai S.-K. et al. Maneuvers to decrease laparoscopy-induced shoulder and upper abdominal pain. Arch. Surg. 2011; 146(12): 1360-6. https://dx.doi.org/10.1001/archsurg.2011.597.
  13. Овечкин А.М., Баялиева А.Ж., Ежевская А.А., Еременко А.А., Заболотский Д.В., Заболотских И.Б., Карелов А.Е., Корячкин В.А., Спасова А.П., Хороненко В.Э., Уваров Д.Н., Ульрих Г.Э., Шадрин Р.В. Послеоперационное обезболивание. Клинические рекомендации. Вестник интенсивной терапии им. А.И. Салтанова. 2019; 4: 9-33. [Ovechkin A.M, Bayalieva A.Zh., Ezhevskaya A.A., Eremenko A.A., Zabolotskij D.V., Zabolotskikh I.B., Karelov A.E., Koryachkin V.A., Spasova A.P., Khoronenko V.E., Uvarov D.N., Ulrich G.E., Shadrin R.V. Postoperative analgesia. Guidelines. Annals of Critical Care. 2019; (4): 9-33. (in Russian)].
  14. Овечкин А.М. Послеоперационная боль: состояние проблемы и современные тенденции послеоперационного обезболивания. Регионарная анестезия и лечение острой боли. 2015; 9(2): 29-39. [Ovechkin A.M. Postoperative pain: the state of problem and current trends in postoperative analgesia. Regional Anesthesia and Acute Pain Management. 2015; 9(2 ): 29-39. (in Russian)].
  15. Tsai H.W., Wang P.H., Yen M.S., Chao K.C., Hsu T.F., Chen Y.J. Prevention of postlaparoscopic shoulder and upper abdominal pain: a randomized controlled trial. Obstet. Gynecol. 2013; 121(3): 526-31. https://dx.doi.org/10.1097/AOG.0b013e318283fcca.
  16. Fernández-López I., Peña-Otero D., Ángeles Atín-Arratibel M., Eguillor-Mutiloa M. Influence of the phrenic nerve in shoulder pain: a systematic review. Int. J. Osteopathic Med. 2020; 36: 36-48. https://dx.doi.org/10.1016/j.ijosm.2020.03.003.
  17. Kaloo P., Armstrong S., Kaloo C., Jordan V. Interventions to reduce shoulder pain following gynaecological laparoscopic procedures. Cochrane Database Syst. Rev. 2019; 1(1): CD011101. https://dx.doi.org/10.1002/14651858.CD011101.pub2.
  18. Tserteli Z., Terry M.L., Bowers S.P., Spivak H., Archer S.B., Galloway K.D. et al. Prospective randomized clinical trial comparing nitrous oxide and carbon dioxide pneumoperitoneums for laparoscopic surgery. J. Am. Coll. Surg. 2002; 195(2): 173-9; discussion 179-80. https://dx.doi.org/10.1016/s1072-7515(02)01194-8.
  19. Aitola P., Airo I., Kaukinen S., Ylitalo P. Comparison of N2O and CO2 pneumoperitoneum during laparoscopic cholecystectomy with special reference to postoperative pain. Surg. Laparosc. Endosc. 1998; 8(2): 140-4.
  20. Wittgen C.M., Andrus C.H., Fitzgerald S.D., Baudendistel L.J., Dahms T.E., Kaminski D.L. Analysis of the hemodynamic and ventilatory effects of laparoscopic cholecystectomy. Arch. Surg. 1991; 126(8): 997-1000; discussion 1000-1. https://dx.doi.org/10.1001/archsurg.1991.01410320083011.
  21. El-Kady A.A., Abd-El-Razek M. Intraperitoneal explosion during female sterilization by laparoscopic electrocouagulation. Int. J. Gynecol. Obstet. 1976; 14(6): 487-8. https://dx.doi.org/10.1002/j.1879-3479.1976.tb00090.x.
  22. Gunatilake D.E. Case report: fatal intraperitoneal explosion during electrocoagulation via laparoscopy. Int. J. Gynecol. Obstet. 1978; 15(4): 353-7. https://dx.doi.org/10.1002/j.1879-3479.1977.tb00708.x.
  23. Cheng Y., Lu J., Xiong X., Wu S., Lin Y., Wu T. et al. Gases for establishing pneumoperitoneum during laparoscopic abdominal surgery. Cochrane Database Syst. Rev. 2013; (1): CD009569. https://dx.doi.org/10.1002/14651858.CD009569.pub2.
  24. Ryu K.-H., Lee S.H., Cho E.-A., Kim J.-A, Lim G.-E., Song T. Comparison of impacts of intraperitoneal saline instillation with and without pulmonary recruitment maneuver on post-laparoscopic shoulder pain prevention: a randomized controlled trial. Surg. Endosc. 2018; 33(3): 870-8.https://dx.doi.org/10.1007/s00464-018-6354-2.
  25. Trout S.W., Kemmann E. Vulvar edema as a complication of laparoscopic surgery. J. Am. Assoc. Gynecol. Laparosc. 1996; 4(1): 81-3.https://dx.doi.org/10.1016/s1074-3804(96)80115-0.
  26. Perry C.P., Tombrello R. Effect of fluid instillation on postlaparoscopy pain. J. Reprod. Med. 1993; 38(10): 768-70.
  27. Царенко С.В. Практический курс ИВЛ. 2007. 160c. [Tsarenko S.V. Practical course of artificial lung ventilation. 2007. 160p. (In Russian)]
  28. Garteiz-Martínez D., Rodríguez-Ayala E., Weber-Sánchez A., Bravo-Torreblanca C., Carbó-Romano R. Pulmonary recruitment can reduce residual pneumoperitoneum and shoulder pain in conventional laparoscopic procedures: results of a randomized controlled trial. Surg. Endosc. 2021; 35(8): 4143-52. https://dx.doi.org/10.1007/s00464-020-07881-1.
  29. Hess D.R. Recruitment maneuvers and PEEP titration. Respir. Care. 2015; 60(11): 1688-704. https://dx.doi.org/10.4187/respcare.04409.
  30. Ярошецкий А.И., Грицан А.И., Авдеев С.Н., Власенко А.В., Еременко А.А., Заболотских И.Б., Зильбер А.П., Киров М.Ю., Лебединский К.М., Лейдерман И.Н., Мазурок В.А., Николаенко Э.М., Проценко Д.Н., Солодов А.А. Диагностика и интенсивная терапия острого респираторного дистресс-синдрома. Анестезиология и реаниматология. 2020; 2: 5-39. [Yaroshetskiy A.I., Gritsan A.I., Avdeev S.N., Vlasenko A.V., Eremenko A.A., Zabolotskikh I.B., Zilber A.P., Kirov M.Yu., Lebedinsky K.M., Leiderman I.N., Mazurok V.A., Nikolaenko E.M., Protsenko D.N., Solodov A.A. Diagnostics and intensive therapy ofAcute Respiratory Distress Syndrome. Russian Journal of Anaesthesiology and Reanimatology. 2020; (2): 5-39. (in Russian)].https://dx.doi.org/10.17116/anaesthesiology20200215.
  31. Lee J., Park C., Kim J., Ki Y., Cha S.H., Kim J.Y. Effect of low-pressure pulmonary recruitment maneuver on postlaparoscopic shoulder pain: randomized controlled trial. J. Minim. Invasive Gynecol. 2020; 27(1): 173-7. https://dx.doi.org/10.1016/j.jmig.2019.03.020.
  32. Yilmaz G., Kiyak H., Akca A., Salihoglu Z. Low-pressure pulmonary recruitment maneuver: equal to or worse than moderate-pressure pulmonary recruitment maneuver in preventing postlaparoscopic shoulder pain? A randomized controlled trial of 72 patients. Wideochir. Inne Tech. Maloinwazyjne. 2020; 15(3): 519-25. https://dx.doi.org/10.5114/wiitm.2019.89831.
  33. Leelasuwattanakul N., Bunyavehchevin S., Sriprachittichai P. Active gas aspiration versus simple gas evacuation to reduce shoulder pain after diagnostic laparoscopy: a randomized controlled trial. J. Obstet. Gynaecol. Res. 2016; 42(2): 190-4. https://dx.doi.org/10.1111/jog.12868.
  34. Chaichian S., Moazzami B., Haghgoo A., Sheibani K. A new approach to an old concept for reducing shoulder pain caused by gynecological laparoscopy. J. Reprod. Infertil. 2018; 19(1): 56-60.
  35. Haghgoo A., Chaichian S., Ghahremani M., Nooriardebili S., Akbaian A., Moazzami B. The use of peritoneal suction drainage to reduce shoulder pain caused by gynecological laparoscopy. Arch. Iran. Med. 2016;19(3): 173-8.
  36. Hosseinzadeh F., Nasiri E., Behroozi T. Investigating the effects of drainage by hemovac drain on shoulder pain after female laparoscopic surgery and comparison with deep breathing technique: a randomized clinical trial study. Surg. Endosc. 2020; 34(12): 5439-46. https://dx.doi.org/10.1007/s00464-019-07339-z.
  37. Asgari Z., Hosseini R., Rastad H., Hosseini L. Does peritoneal suction drainage reduce pain after gynecologic laparoscopy? Surg. Laparosc. Endosc. Percutan. Tech. 2018; 28(2): 73-6. https://dx.doi.org/10.1097/SLE.0000000000000490.
  38. Radosa J.C., Radosa M.P., Schweitzer P.A., Radosa C.G., Stotz L., Hamza A. et al. Impact of different intraoperative CO2 pressure levels (8 and 15 mmHg) during laparoscopic hysterectomy performed due to benign uterine pathologies on postoperative pain and arterial pCO2: a prospective randomised controlled clinical trial. BJOG. 2019; 126(10): 1276-85. https://dx.doi.org/10.1111/1471-0528.15826.
  39. Topçu H.O., Cavcaytar S., Kokanalı K., Guzel A.I., Islimye M., Doganay M.A. A prospective randomized trial of postoperative pain following different insufflation pressures during gyneco- logic laparoscopy. Eur. J. Obstet. Gynecol. Reprod. Biol. 2014; 182: 81-5. https://dx.doi.org/10.1016/j.ejogrb.2014.09.003.
  40. Hamer J., Jones E., Chan A., Tahmasebi F. Can we routinely employ the use of low-pressure gynaecological laparoscopy? A systematic review. Cureus. 2021; 13(5): e15348. https://dx.doi.org/10.7759/cureus.15348.
  41. Cunningham T.K., Draper H., Bexhell H., Allgar V., Allen J., Mikl D. et al. A double-blinded randomised controlled study to investigate the effect of intraperitoneal levobupivacaine on post laparoscopic pain. Facts Views Vis. Obgyn. 2020; 12(3): 155-61.
  42. Coughlin S.M., Karanicolas P.J., Emmerton-Coughlin H.M., Kanbur B., Kanbur S., Colquhoun P.H. Better late than never? Impact of local analgesia timing on postoperative pain in laparoscopic surgery: a systematic review and metaanalysis. Surg. Endosc. 2010; 24(12): 3167-76. https://dx.doi.org/10.1007/s00464-010-1111-1.

Received 13.06.2023

Accepted 20.06.2023

About the Authors

Ekaterina A. Shapovalova, PhD, obstetrician-gynecologist, Saint Petersburg State University Hospital, 199034, Russia, Saint Petersburg, Fontanka Embankment, 154,
https://orcid.org/0000-0002-4574-2492
Alexander S. Basos, PhD, obstetrician-gynecologist, Saint Petersburg State University Hospital, 199034, Russia, Saint Petersburg, Fontanka Embankment, 154,
https://orcid.org/0000-0001-5020-9759
Irina A. Shkarupa, Deputy Director for Medical Affairs (Gynecology), obstetrician-gynecologist, Saint Petersburg State University Hospital, 199034, Russia, Saint Petersburg, Fontanka Embankment, 154.
Zhanna V. Glushchenko, Head of the Department of Gynecology, obstetrician-gynecologist, Saint Petersburg State University Hospital, 199034, Russia, Saint Petersburg, Fontanka Embankment, 154, https://orcid.org/0000-0001-9698-2253
Sergey М. Тereshin, obstetrician-gynecologist, Saint Petersburg State University Hospital, 199034, Russia, Saint Petersburg, Fontanka Embankment, 154,
https://orcid.org/0009-0004-4273-6259
Ulyana F. Babina, Resident of the Department of Obstetrics and Gynecology, Dzhanelidze Saint Petersburg Research Institute of Emergency Care,
192242, Russia, Saint Petersburg, Budapest str., 3, lit. A, https://orcid.org/0009-0009-6811-3128
Anna A. Savina, Resident of the Department of Obstetrics, Gynecology and Reproductology, Saint Petersburg State University, 199034, Russia, Saint Petersburg,
University Embankment, 7-9, https://orcid.org/0000-0002-3878-8492
Anna V. Shiryaeva, Resident of the Department of Obstetrics, Gynecology and Reproductology, Pavlov First Saint Petersburg State Medical University,
Ministry of Health of Russia, 197022, Russia, Saint Petersburg, Leo Tolstoy str., 6-8, https://orcid.org/0009-0005-6857-0549
Corresponding author: Ekaterina A. Shapovalova, katerina_andmed@mail.ru

Similar Articles

№9 / 2020
Buyanova S.N., Logutova L.S., Shchukinа N.A., Voloshchuk I.N., Babunashvili E.L., Barto R.A., Yudinа N.V., Gukasyan S.A.
Parasitic myomas and adenomyomas after myomectomy
№5 / 2019
Rukhliada N.N., Krylov K.Yu., Biryukova E.I.
Organ-sparing surgery for adenomyosis
№8 / 2023
Sotskiy P.O., Sotskaya O.L., Safaryan M.D., Mkhitaryan A.G., Hayrapetyan H.S.
The role of laparoscopy in the diagnosis of infertility in patients with familial Mediterranean fever
№2 / 2023
Bezhenar V.F., Krylov K.Yu., Makarenko T.A., Matukhin V.I., Rukhlyada N.N., Tskhay V.B.
Experience with surgery for adenomyosis and assessment of reproductive outcomes
№4 / 2024
Loginova E.A., Valiev R.K., Ivanova L.B., Davydova I.Yu., Dymova A.V.
Uterine niches following cesarean section: the problem of diagnosis and treatment
By continuing to use our site, you consent to the processing of cookies that ensure the proper functioning of the site.