Myung Sub Yi1, Won Joong Kim2, Min Kyoung Kim1, Hyun Kang1, Yong-Hee Park1, Yong Hun Jung1, Seung Eun Lee3, Hwa Yong Shin4. 1. Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Chung-Ang University Hospital, 224-1 Heukseok-dong, Dongjak-gu, Seoul, 156-755, Republic of Korea. 2. Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, Republic of Korea. 3. Department of Surgery, College of Medicine, Chung-Ang University, Chung-Ang University Hospital, 224-1 Heukseok-dong, Dongjak-gu, Seoul, 156-755, Republic of Korea. 4. Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Chung-Ang University Hospital, 224-1 Heukseok-dong, Dongjak-gu, Seoul, 156-755, Republic of Korea. pain@cau.ac.kr.
Abstract
BACKGROUND: Post-laparoscopic shoulder pain (PLSP) frequently follows a laparoscopic cholecystectomy. A proposed mechanism for PLSP is the irritation or injury of the phrenic nerve by the CO2 pneumoperitoneum during laparoscopic surgery. Here, we investigated whether a phrenic nerve block (PNB), performed under ultrasound guidance, could reduce the incidence and severity of PLSP after laparoscopic cholecystectomy. METHOD:Sixty patients were randomized into two groups, with one group receiving PNB with 4 ml (30 mg) of 0.75% ropivacaine (group P, n = 28) and a control group (group C, n = 32). The existence and severity of PLSP were assessed for 2 days postoperatively. A pulmonary function test (PFT) and diaphragmatic excursion test were performed pre- and postoperatively. RESULTS: With ultrasound guidance, all PNBs were performed successfully in group P. In group P, the overall incidence and severity of PLSP decreased significantly. There were no significant differences in incisional pain, visceral pain, and analgesic requirements between the groups. Right-side diaphragmatic excursion decreased significantly in group P at 1 h postoperatively. The PFT results and respiratory discomfort assessed by a modified Borg's scale were not different significantly between the groups. CONCLUSION: Based on these findings, ultrasound-guided PNB can prevent or reduce the PLSP without clinically significant respiratory discomfort.
RCT Entities:
BACKGROUND: Post-laparoscopic shoulder pain (PLSP) frequently follows a laparoscopic cholecystectomy. A proposed mechanism for PLSP is the irritation or injury of the phrenic nerve by the CO2 pneumoperitoneum during laparoscopic surgery. Here, we investigated whether a phrenic nerve block (PNB), performed under ultrasound guidance, could reduce the incidence and severity of PLSP after laparoscopic cholecystectomy. METHOD: Sixty patients were randomized into two groups, with one group receiving PNB with 4 ml (30 mg) of 0.75% ropivacaine (group P, n = 28) and a control group (group C, n = 32). The existence and severity of PLSP were assessed for 2 days postoperatively. A pulmonary function test (PFT) and diaphragmatic excursion test were performed pre- and postoperatively. RESULTS: With ultrasound guidance, all PNBs were performed successfully in group P. In group P, the overall incidence and severity of PLSP decreased significantly. There were no significant differences in incisional pain, visceral pain, and analgesic requirements between the groups. Right-side diaphragmatic excursion decreased significantly in group P at 1 h postoperatively. The PFT results and respiratory discomfort assessed by a modified Borg's scale were not different significantly between the groups. CONCLUSION: Based on these findings, ultrasound-guided PNB can prevent or reduce the PLSP without clinically significant respiratory discomfort.
Authors: Steven H Renes; Geert J van Geffen; Harald C Rettig; Mathieu J Gielen; Gert J Scheffer Journal: Reg Anesth Pain Med Date: 2010 Sep-Oct Impact factor: 6.288