A prospective randomized trial of intraoperative bupivacaine irrigation for management of shoulder-tip pain following laparoscopy
Background: Postoperative shoulder-tip pain (STP) frequently occurs following laparoscopic surgery. In an attempt to abrogate this complication we prospectively evaluated the efficacy of intraoperative irrigation of the diaphragm with bupivacaine. Methods: One hundred and five consecutive patients u...
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| Veröffentlicht in: | The American journal of surgery 1998-09, Vol.176 (3), p.258-261 |
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| creator | Cunniffe, M.Geraldine McAnena, Oliver J Dar, Manzoor A Calleary, John Flynn, Noel |
| description | Background: Postoperative shoulder-tip pain (STP) frequently occurs following laparoscopic surgery. In an attempt to abrogate this complication we prospectively evaluated the efficacy of intraoperative irrigation of the diaphragm with bupivacaine.
Methods: One hundred and five consecutive patients undergoing laparoscopic surgery were prospectively randomized to treatment or control groups. Treatment group (B, n = 55) received irrigation with 10 mL 0.5% bupivacaine in 500 mL saline and control group (A, n = 50) received an equal volume of normal saline. Each dome of the diaphragm was irrigated with 250 mL of either solution at the end of surgery. Laparoscopic procedures performed included cholecystectomy (n = 63), Nissen fundoplication (n = 21), appendicectomy (n = 7), hernia repair (n = 4), and diagnostic laparoscopy (n = 10). Patients’ anesthesia and perioperative analgesia were standardized. STP was recorded on a visual analogue pain scale (VAPS) in the recovery room immediately following surgery and at 4, 10, and 24 hours thereafter.
Results: The overall incidence of STP in patients undergoing laparoscopic procedures was approximately 24%. Twenty-one patients (42%) in the control group and 4 patients (7%) in the treatment group complained of shoulder pain during the recording period (
P = 0.003). Mean STP scores as recorded on VAPS were significantly lower in the bupivacaine group than in the control group from 4 to 24 hours after surgery (
P |
| doi_str_mv | 10.1016/S0002-9610(98)00150-0 |
| format | Article |
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Methods: One hundred and five consecutive patients undergoing laparoscopic surgery were prospectively randomized to treatment or control groups. Treatment group (B, n = 55) received irrigation with 10 mL 0.5% bupivacaine in 500 mL saline and control group (A, n = 50) received an equal volume of normal saline. Each dome of the diaphragm was irrigated with 250 mL of either solution at the end of surgery. Laparoscopic procedures performed included cholecystectomy (n = 63), Nissen fundoplication (n = 21), appendicectomy (n = 7), hernia repair (n = 4), and diagnostic laparoscopy (n = 10). Patients’ anesthesia and perioperative analgesia were standardized. STP was recorded on a visual analogue pain scale (VAPS) in the recovery room immediately following surgery and at 4, 10, and 24 hours thereafter.
Results: The overall incidence of STP in patients undergoing laparoscopic procedures was approximately 24%. Twenty-one patients (42%) in the control group and 4 patients (7%) in the treatment group complained of shoulder pain during the recording period (
P = 0.003). Mean STP scores as recorded on VAPS were significantly lower in the bupivacaine group than in the control group from 4 to 24 hours after surgery (
P <0.01). Postoperative analgesia requirements were also significantly reduced in those patients receiving bupivacaine irrigation (
P <0.04).
Conclusion: Intraperitoneal irrigation with bupivacaine to both hemidiaphragms at the end of surgery significantly reduces both frequency and intensity of STP following laparoscopic procedures thus reducing patient morbidity.</description><identifier>ISSN: 0002-9610</identifier><identifier>EISSN: 1879-1883</identifier><identifier>DOI: 10.1016/S0002-9610(98)00150-0</identifier><identifier>PMID: 9776154</identifier><identifier>CODEN: AJSUAB</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject><![CDATA[Abdomen ; Adolescent ; Adult ; Aged ; Analgesia ; Analgesics ; Anesthesia ; Anesthesia, General ; Anesthetics, Local - administration & dosage ; Appendectomy ; Biological and medical sciences ; Bupivacaine ; Bupivacaine - administration & dosage ; Cholecystectomy ; Diaphragm ; Female ; Hernia ; Hernias ; Humans ; Intraoperative Care - methods ; Intraoperative Care - statistics & numerical data ; Irrigation ; Laparoscopy ; Laparoscopy - adverse effects ; Laparoscopy - statistics & numerical data ; Lavage ; Male ; Medical sciences ; Middle Aged ; Morbidity ; Morphine ; Neuropharmacology ; Pain ; Pain perception ; Pain, Postoperative - prevention & control ; Patients ; Peritoneal Cavity ; Pharmacology. Drug treatments ; Postoperative period ; Prospective Studies ; Shoulder ; Shoulder Pain - prevention & control ; Surgery ; Therapeutic Irrigation - methods ; Toxicity]]></subject><ispartof>The American journal of surgery, 1998-09, Vol.176 (3), p.258-261</ispartof><rights>1998 Excerpta Medica Inc.</rights><rights>1998 INIST-CNRS</rights><rights>1998. Excerpta Medica Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c417t-a1a37e747b080e6eb73eaea23500cccf5847b67dc9d695bbca4cfab0fdab04093</citedby><cites>FETCH-LOGICAL-c417t-a1a37e747b080e6eb73eaea23500cccf5847b67dc9d695bbca4cfab0fdab04093</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002961098001500$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=2408647$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9776154$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cunniffe, M.Geraldine</creatorcontrib><creatorcontrib>McAnena, Oliver J</creatorcontrib><creatorcontrib>Dar, Manzoor A</creatorcontrib><creatorcontrib>Calleary, John</creatorcontrib><creatorcontrib>Flynn, Noel</creatorcontrib><title>A prospective randomized trial of intraoperative bupivacaine irrigation for management of shoulder-tip pain following laparoscopy</title><title>The American journal of surgery</title><addtitle>Am J Surg</addtitle><description>Background: Postoperative shoulder-tip pain (STP) frequently occurs following laparoscopic surgery. In an attempt to abrogate this complication we prospectively evaluated the efficacy of intraoperative irrigation of the diaphragm with bupivacaine.
Methods: One hundred and five consecutive patients undergoing laparoscopic surgery were prospectively randomized to treatment or control groups. Treatment group (B, n = 55) received irrigation with 10 mL 0.5% bupivacaine in 500 mL saline and control group (A, n = 50) received an equal volume of normal saline. Each dome of the diaphragm was irrigated with 250 mL of either solution at the end of surgery. Laparoscopic procedures performed included cholecystectomy (n = 63), Nissen fundoplication (n = 21), appendicectomy (n = 7), hernia repair (n = 4), and diagnostic laparoscopy (n = 10). Patients’ anesthesia and perioperative analgesia were standardized. STP was recorded on a visual analogue pain scale (VAPS) in the recovery room immediately following surgery and at 4, 10, and 24 hours thereafter.
Results: The overall incidence of STP in patients undergoing laparoscopic procedures was approximately 24%. Twenty-one patients (42%) in the control group and 4 patients (7%) in the treatment group complained of shoulder pain during the recording period (
P = 0.003). Mean STP scores as recorded on VAPS were significantly lower in the bupivacaine group than in the control group from 4 to 24 hours after surgery (
P <0.01). Postoperative analgesia requirements were also significantly reduced in those patients receiving bupivacaine irrigation (
P <0.04).
Conclusion: Intraperitoneal irrigation with bupivacaine to both hemidiaphragms at the end of surgery significantly reduces both frequency and intensity of STP following laparoscopic procedures thus reducing patient morbidity.</description><subject>Abdomen</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Analgesia</subject><subject>Analgesics</subject><subject>Anesthesia</subject><subject>Anesthesia, General</subject><subject>Anesthetics, Local - administration & dosage</subject><subject>Appendectomy</subject><subject>Biological and medical sciences</subject><subject>Bupivacaine</subject><subject>Bupivacaine - administration & dosage</subject><subject>Cholecystectomy</subject><subject>Diaphragm</subject><subject>Female</subject><subject>Hernia</subject><subject>Hernias</subject><subject>Humans</subject><subject>Intraoperative Care - methods</subject><subject>Intraoperative Care - statistics & numerical data</subject><subject>Irrigation</subject><subject>Laparoscopy</subject><subject>Laparoscopy - adverse effects</subject><subject>Laparoscopy - statistics & numerical data</subject><subject>Lavage</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Morphine</subject><subject>Neuropharmacology</subject><subject>Pain</subject><subject>Pain perception</subject><subject>Pain, Postoperative - prevention & control</subject><subject>Patients</subject><subject>Peritoneal Cavity</subject><subject>Pharmacology. Drug treatments</subject><subject>Postoperative period</subject><subject>Prospective Studies</subject><subject>Shoulder</subject><subject>Shoulder Pain - prevention & control</subject><subject>Surgery</subject><subject>Therapeutic Irrigation - methods</subject><subject>Toxicity</subject><issn>0002-9610</issn><issn>1879-1883</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1998</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkU2L1TAUhoMo43X0JwwEFNFFNWnTplnJMPgFAy7UdThNT68Z2qQm7ZVx5z_33A_uwo2bhOR9zufL2JUUb6SQzduvQoiyMI0Ur0z7WghZi0I8YBvZalPItq0ess0Zecye5HxHTylVdcEujNaNrNWG_bnmc4p5Rrf4HfIEoY-T_409X5KHkceB-7AkiDMmOCDdOvsdOPABuU_Jb-k7Bj7ExCcIsMUJw7KPyz_iOvaYisXPfCaemHGMv3zY8hFmoLIuzvdP2aMBxozPTvcl-_7h_bebT8Xtl4-fb65vC6ekXgqQUGnUSneiFdhgpysEhLKqhXDODXVLUqN7Z_rG1F3nQLkBOjH0dChhqkv28piX5v25Yl7s5LPDcYSAcc22MaZRrSwJfP4PeBfXFKg3W1IRVWtaI1H1kXI0R0442Dn5CdK9lcLuDbIHg-x--9a09mCQFRR3dcq-dhP256iTI6S_OOmQHYwDOeJ8PmOlEm2jNGHvjhjSynYek83OY3DY-0Re2j76_zTyF2JnsDc</recordid><startdate>19980901</startdate><enddate>19980901</enddate><creator>Cunniffe, M.Geraldine</creator><creator>McAnena, Oliver J</creator><creator>Dar, Manzoor A</creator><creator>Calleary, John</creator><creator>Flynn, Noel</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>19980901</creationdate><title>A prospective randomized trial of intraoperative bupivacaine irrigation for management of shoulder-tip pain following laparoscopy</title><author>Cunniffe, M.Geraldine ; McAnena, Oliver J ; Dar, Manzoor A ; Calleary, John ; Flynn, Noel</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c417t-a1a37e747b080e6eb73eaea23500cccf5847b67dc9d695bbca4cfab0fdab04093</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1998</creationdate><topic>Abdomen</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Analgesia</topic><topic>Analgesics</topic><topic>Anesthesia</topic><topic>Anesthesia, General</topic><topic>Anesthetics, Local - administration & dosage</topic><topic>Appendectomy</topic><topic>Biological and medical sciences</topic><topic>Bupivacaine</topic><topic>Bupivacaine - administration & dosage</topic><topic>Cholecystectomy</topic><topic>Diaphragm</topic><topic>Female</topic><topic>Hernia</topic><topic>Hernias</topic><topic>Humans</topic><topic>Intraoperative Care - methods</topic><topic>Intraoperative Care - statistics & numerical data</topic><topic>Irrigation</topic><topic>Laparoscopy</topic><topic>Laparoscopy - adverse effects</topic><topic>Laparoscopy - statistics & numerical data</topic><topic>Lavage</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>Morphine</topic><topic>Neuropharmacology</topic><topic>Pain</topic><topic>Pain perception</topic><topic>Pain, Postoperative - prevention & control</topic><topic>Patients</topic><topic>Peritoneal Cavity</topic><topic>Pharmacology. Drug treatments</topic><topic>Postoperative period</topic><topic>Prospective Studies</topic><topic>Shoulder</topic><topic>Shoulder Pain - prevention & control</topic><topic>Surgery</topic><topic>Therapeutic Irrigation - methods</topic><topic>Toxicity</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cunniffe, M.Geraldine</creatorcontrib><creatorcontrib>McAnena, Oliver J</creatorcontrib><creatorcontrib>Dar, Manzoor A</creatorcontrib><creatorcontrib>Calleary, John</creatorcontrib><creatorcontrib>Flynn, Noel</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cunniffe, M.Geraldine</au><au>McAnena, Oliver J</au><au>Dar, Manzoor A</au><au>Calleary, John</au><au>Flynn, Noel</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A prospective randomized trial of intraoperative bupivacaine irrigation for management of shoulder-tip pain following laparoscopy</atitle><jtitle>The American journal of surgery</jtitle><addtitle>Am J Surg</addtitle><date>1998-09-01</date><risdate>1998</risdate><volume>176</volume><issue>3</issue><spage>258</spage><epage>261</epage><pages>258-261</pages><issn>0002-9610</issn><eissn>1879-1883</eissn><coden>AJSUAB</coden><abstract>Background: Postoperative shoulder-tip pain (STP) frequently occurs following laparoscopic surgery. In an attempt to abrogate this complication we prospectively evaluated the efficacy of intraoperative irrigation of the diaphragm with bupivacaine.
Methods: One hundred and five consecutive patients undergoing laparoscopic surgery were prospectively randomized to treatment or control groups. Treatment group (B, n = 55) received irrigation with 10 mL 0.5% bupivacaine in 500 mL saline and control group (A, n = 50) received an equal volume of normal saline. Each dome of the diaphragm was irrigated with 250 mL of either solution at the end of surgery. Laparoscopic procedures performed included cholecystectomy (n = 63), Nissen fundoplication (n = 21), appendicectomy (n = 7), hernia repair (n = 4), and diagnostic laparoscopy (n = 10). Patients’ anesthesia and perioperative analgesia were standardized. STP was recorded on a visual analogue pain scale (VAPS) in the recovery room immediately following surgery and at 4, 10, and 24 hours thereafter.
Results: The overall incidence of STP in patients undergoing laparoscopic procedures was approximately 24%. Twenty-one patients (42%) in the control group and 4 patients (7%) in the treatment group complained of shoulder pain during the recording period (
P = 0.003). Mean STP scores as recorded on VAPS were significantly lower in the bupivacaine group than in the control group from 4 to 24 hours after surgery (
P <0.01). Postoperative analgesia requirements were also significantly reduced in those patients receiving bupivacaine irrigation (
P <0.04).
Conclusion: Intraperitoneal irrigation with bupivacaine to both hemidiaphragms at the end of surgery significantly reduces both frequency and intensity of STP following laparoscopic procedures thus reducing patient morbidity.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>9776154</pmid><doi>10.1016/S0002-9610(98)00150-0</doi><tpages>4</tpages></addata></record> |
| fulltext | fulltext |
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| ispartof | The American journal of surgery, 1998-09, Vol.176 (3), p.258-261 |
| issn | 0002-9610 1879-1883 |
| language | eng |
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| subjects | Abdomen Adolescent Adult Aged Analgesia Analgesics Anesthesia Anesthesia, General Anesthetics, Local - administration & dosage Appendectomy Biological and medical sciences Bupivacaine Bupivacaine - administration & dosage Cholecystectomy Diaphragm Female Hernia Hernias Humans Intraoperative Care - methods Intraoperative Care - statistics & numerical data Irrigation Laparoscopy Laparoscopy - adverse effects Laparoscopy - statistics & numerical data Lavage Male Medical sciences Middle Aged Morbidity Morphine Neuropharmacology Pain Pain perception Pain, Postoperative - prevention & control Patients Peritoneal Cavity Pharmacology. Drug treatments Postoperative period Prospective Studies Shoulder Shoulder Pain - prevention & control Surgery Therapeutic Irrigation - methods Toxicity |
| title | A prospective randomized trial of intraoperative bupivacaine irrigation for management of shoulder-tip pain following laparoscopy |
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