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Effect of ultrasound-guided phrenic nerve block on shoulder pain after laparoscopic cholecystectomy—a prospective, randomized controlled trial

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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.

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References

  1. Mouton WG, Bessell JR, Otten KT, Maddern GJ (1999) Pain after laparoscopy. Surg Endosc 13(5):445–448

    Article  CAS  PubMed  Google Scholar 

  2. Nyerges A (1994) Pain mechanisms in laparoscopic surgery. Semin Laparosc Surg 1(4):215–218

    CAS  PubMed  Google Scholar 

  3. Shin HY, Kim SH, Lee YJ, Kim DK (2010) The effect of mechanical ventilation tidal volume during pneumoperitoneum on shoulder pain after a laparoscopic appendectomy. Surg Endosc 24(8):2002–2007

    Article  PubMed  Google Scholar 

  4. Coventry DM (1995) Anaesthesia for laparoscopic surgery. J R Coll Surg Edinb 40(3):151–160

    CAS  PubMed  Google Scholar 

  5. Yu TC, Hamill JK, Liley A, Hill AG (2013) Warm, humidified carbon dioxide gas insufflation for laparoscopic appendicectomy in children: a double-blinded randomized controlled trial. Ann Surg 257(1):44–53

    Article  PubMed  Google Scholar 

  6. Aitola P, Airo I, Kaukinen S, Ylitalo P (1998) Comparison of N2O and CO2 pneumoperitoneums during laparoscopic cholecystectomy with special reference to postoperative pain. Surg Laparosc Endosc 8(2):140–144

    Article  CAS  PubMed  Google Scholar 

  7. Corsale I, Fantini C, Gentili C, Sapere P, Garruto O, Conte R (2000) Peritoneal innervation and post-laparoscopic course. Role of CO2. Minerva Chir 55(4):205–210

    CAS  PubMed  Google Scholar 

  8. Sammour T, Kahokehr A, Hayes J, Hulme-Moir M, Hill AG (2010) Warming and humidification of insufflation carbon dioxide in laparoscopic colonic surgery: a double-blinded randomized controlled trial. Ann Surg 251(6):1024–1033

    Article  PubMed  Google Scholar 

  9. Sarli L, Costi R, Sansebastiano G, Trivelli M, Roncoroni L (2000) Prospective randomized trial of low-pressure pneumoperitoneum for reduction of shoulder-tip pain following laparoscopy. Br J Surg 87(9):1161–1165

    Article  CAS  PubMed  Google Scholar 

  10. Berberoglu M, Dilek ON, Ercan F, Kati I, Ozmen M (1998) The effect of CO2 insufflation rate on the postlaparoscopic shoulder pain. J Laparoendosc Adv Surg Tech Part A. 8(5):273–277

    Article  CAS  Google Scholar 

  11. Koivusalo AM, Kellokumpu I, Lindgren L (1996) Gasless laparoscopic cholecystectomy: comparison of postoperative recovery with conventional technique. Br J Anaesth 77(5):576–580

    Article  CAS  PubMed  Google Scholar 

  12. Vezakis A, Davides D, Gibson JS et al (1999) Randomized comparison between low-pressure laparoscopic cholecystectomy and gasless laparoscopic cholecystectomy. Surg Endosc 13(9):890–893

    Article  CAS  PubMed  Google Scholar 

  13. Slim K, Bousquet J, Kwiatkowski F, Lescure G, Pezet D, Chipponi J (1999) Effect of CO(2) gas warming on pain after laparoscopic surgery: a randomized double-blind controlled trial. Surg Endosc 13(11):1110–1114

    Article  CAS  PubMed  Google Scholar 

  14. Phinchantra P, Bunyavehchevin S, Suwajanakorn S, Wisawasukmongchol W (2004) The preemptive analgesic effect of celecoxib for day-case diagnostic laparoscopy. J Med Assoc Thail = Chotmaihet Thangphaet 87(3):283–288

    Google Scholar 

  15. Valadan M, Banifatemi S, Yousefshahi F (2015) Preoperative gabapentin to prevent postoperative shoulder pain after laparoscopic ovarian cystectomy: a randomized clinical trial. Anesthesiol Pain Med 5(6):e31524

    Article  Google Scholar 

  16. Cunniffe MG, McAnena OJ, Dar MA, Calleary J, Flynn N (1998) A prospective randomized trial of intraoperative bupivacaine irrigation for management of shoulder-tip pain following laparoscopy. Am J Surg 176(3):258–261

    Article  CAS  PubMed  Google Scholar 

  17. Jorgensen JO, Gillies RB, Hunt DR, Caplehorn JR, Lumley T (1995) A simple and effective way to reduce postoperative pain after laparoscopic cholecystectomy. Aust N Z J Surg 65(7):466–469

    Article  CAS  PubMed  Google Scholar 

  18. Johnson N, Onwude JL, Player J et al (1994) Pain after laparoscopy: an observational study and a randomized trial of local anesthetic. J Gynecol Surg 10(3):129–138

    Article  CAS  PubMed  Google Scholar 

  19. Gharaibeh KI, Al-Jaberi TM (2000) Bupivacaine instillation into gallbladder bed after laparoscopic cholecystectomy: does it decrease shoulder pain? J Laparoendosc Adv Surg Tech Part A 10(3):137–141

    Article  CAS  Google Scholar 

  20. Matsui K, Yoshida M, Maemura Y, Ichihara Y, Yamagami M, Kikuchi H (1994) Significance of phrenic nerve block in the anesthetic management of laparoscopic cholecystectomy. Masui 43(11):1718–1721

    CAS  PubMed  Google Scholar 

  21. Dogan R, Sahin D, Isbilen C (2008) Laparoscopic cholecystectomy under spinal anesthesia with right phrenic nerve block. Acta Anaesthesiol Scand 52(3):445–446

    Article  CAS  PubMed  Google Scholar 

  22. Renes SH, van Geffen GJ, Rettig HC, Gielen MJ, Scheffer GJ (2010) Ultrasound-guided continuous phrenic nerve block for persistent hiccups. Reg Anesth Pain Med 35(5):455–457

    Article  PubMed  Google Scholar 

  23. Kessler J, Schafhalter-Zoppoth I, Gray AT (2008) An ultrasound study of the phrenic nerve in the posterior cervical triangle: implications for the interscalene brachial plexus block. Reg Anesth Pain Med 33(6):545–550

    PubMed  Google Scholar 

  24. Kang SS, Jang JS, Park JH, Hong SJ, Shin KM, Yun YJ (2009) Unilateral phrenic nerve block guided by ultrasonography and nerve stimulator for the treatment of hiccup developed after tongue cancer operation: a case report. Korean J Anesthesiol 56(2):208–210

    Article  Google Scholar 

  25. Cha SM, Kang H, Baek CW et al (2012) Peritrocal and intraperitoneal ropivacaine for laparoscopic cholecystectomy: a prospective, randomized, double-blind controlled trial. J Surg Res 175(2):251–258

    Article  CAS  PubMed  Google Scholar 

  26. Chang SH, Lee HW, Kim HK, Kim SH, Kim DK (2009) An evaluation of perioperative pregabalin for prevention and attenuation of postoperative shoulder pain after laparoscopic cholecystectomy. Anesth Analg 109(4):1284–1286

    Article  PubMed  Google Scholar 

  27. Kim JY, Song KS, Kim WJ et al (2016) Analgesic efficacy of two interscalene blocks and one cervical epidural block in arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 24(3):931–939

    Article  CAS  PubMed  Google Scholar 

  28. Boussuges A, Gole Y, Blanc P (2009) Diaphragmatic motion studied by m-mode ultrasonography: methods, reproducibility, and normal values. Chest 135(2):391–400

    Article  PubMed  Google Scholar 

  29. Dixon JB, Reuben Y, Halket C, O’Brien PE (2005) Shoulder pain is a common problem following laparoscopic adjustable gastric band surgery. Obes Surg 15(8):1111–1117

    Article  PubMed  Google Scholar 

  30. Dobbs FF, Kumar V, Alexander JI, Hull MG (1987) Pain after laparoscopy related to posture and ring versus clip sterilization. Br J Obstet Gynaecol 94(3):262–266

    Article  CAS  PubMed  Google Scholar 

  31. Kandil TS, Hefnawy EE (2010) Shoulder pain following laparoscopic cholecystectomy: factors affecting the incidence and severity. J Laparoendosc Adv Surg Tech A 20(8):677–682

    Article  PubMed  Google Scholar 

  32. Collins SL, Moore RA, McQuay HJ (1997) The visual analogue pain intensity scale: what is moderate pain in millimetres? Pain 72(1–2):95–97

    Article  CAS  PubMed  Google Scholar 

  33. Wong CS, Cousins G, Duddy JC, Walsh SR (2015) Intra-abdominal drainage for laparoscopic cholecystectomy: a systematic review and meta-analysis. Int J Surg (London, England) 23((Pt A)):87–96

    Article  Google Scholar 

  34. Picchio M, Lucarelli P, Di Filippo A, De Angelis F, Stipa F, Spaziani E (2014) Meta-analysis of drainage versus no drainage after laparoscopic cholecystectomy. JSLS. doi:10.4293/JSLS.2014.00242

    PubMed  PubMed Central  Google Scholar 

  35. Donatsky AM, Bjerrum F, Gogenur I (2013) Surgical techniques to minimize shoulder pain after laparoscopic cholecystectomy. A systematic review. Surg Endosc 27(7):2275–2282

    Article  PubMed  Google Scholar 

  36. Donatsky AM, Bjerrum F, Gogenur I (2013) Intraperitoneal instillation of saline and local anesthesia for prevention of shoulder pain after laparoscopic cholecystectomy: a systematic review. Surg Endosc 27(7):2283–2292

    Article  PubMed  Google Scholar 

  37. Hua J, Gong J, Yao L, Zhou B, Song Z (2014) Low-pressure versus standard-pressure pneumoperitoneum for laparoscopic cholecystectomy: a systematic review and meta-analysis. Am J Surg 208(1):143–150

    Article  PubMed  Google Scholar 

  38. Pergialiotis V, Vlachos DE, Kontzoglou K, Perrea D, Vlachos GD (2015) Pulmonary recruitment maneuver to reduce pain after laparoscopy: a meta-analysis of randomized controlled trials. Surg Endosc 29(8):2101–2108

    Article  PubMed  Google Scholar 

  39. Kang KN, Park IK, Suh JH, Leem JG, Shin JW (2010) Ultrasound-guided pulsed radiofrequency lesioning of the phrenic nerve in a patient with intractable hiccup. Korean J Pain 23(3):198–201

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

This research was supported by Chung-Ang University Research Grants in 2015.

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Authors and Affiliations

  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

    Myung Sub Yi, Min Kyoung Kim, Hyun Kang, Yong-Hee Park, Yong Hun Jung & Hwa Yong Shin

  2. Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, Republic of Korea

    Won Joong Kim

  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

    Seung Eun Lee

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  1. Myung Sub Yi
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Correspondence to Hwa Yong Shin.

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Disclosures

Drs. Myung Sub Yi, Won Joong Kim, Min Kyoung Kim, Hyun Kang, Yong Hee Park, Yong Hun Jung, Seung Eun Lee, and Hwa Yong Shin have no conflicts of interest or financial ties to disclose.

Additional information

IRB: No. C2011159(609) by IRB of Chung-Ang University Hospital

Clinical Registry: Clinical Research Information Service, KCT0001551, Hwa Yong Shin, 2015-08-03, https://cris.nih.go.kr/cris/en/search/search_result_st01.jsp?seq=5189.

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Yi, M.S., Kim, W.J., Kim, M.K. et al. Effect of ultrasound-guided phrenic nerve block on shoulder pain after laparoscopic cholecystectomy—a prospective, randomized controlled trial. Surg Endosc 31, 3637–3645 (2017). https://doi.org/10.1007/s00464-016-5398-4

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  • DOI: https://doi.org/10.1007/s00464-016-5398-4

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