The Clinical Investigations Of Pain On The Shoulders And Epigastrium After The Reprotenal Laparoscopic Operations

Objective: To discuss the reason of pain on the shoulders and epigastrium after the reprotenal laparoscopic operations.Methods: 108 patients had undergone the laparoscopic adrenalectomy or laparoscopic renal cyst unroofing in our hospital from Jan 2004 to Apr 2007. They were divided into two groups at random, group A and group B. In group A, we discharged the carbon dioxide (CO2) as soon as we finished the operation, but we did not in group B. Between group A and group B, there were no difference in age,statue,weight,operation time anaesesthesia time CO2-pheunoperitonum time and pressure. All the operations were finished by the same operators. During the operations, the carbon dioxide inflation rate was 2L/min and the pressure was kept between 13mmHg and 14mmHg. At the same period, there were 49 patients who had received retroperitoneal laparoscopic radical nephrectomy, and the 49 cases were divided into two groups by the CO2-pheunopertomeum time, group C and group D. In the group D, the CO2-pheunopertomeum time was over 90 minutes, and the time was less than 90 minutes in the group C. The arterial blood gas analysis was monitored 1 day before and after operation in group A and B. We evaluated the pain degree through the vision analogue score (VAS) at the 1st,3 rd,6th,12th,24th,72nd and 96th postoperation.Results: The incidence rate of pain postoperation was significantly higher in group B than in group A (p<0.05), and the grade of VSA in group B was higher than that in group A. In group A and B, the pain aggravated as the time passed by, and the peak time of pain was 24 hours after operation. In group A and group B, there was no difference in the pressure of CO2 in the arterial blood(p>0.05). The incidence rate of pain and the grade of VSA both were significantly higher in group D than that in group C(p<0.05). Conclusions: The degree of pain postoperation relates to theCO2-pheunopertomeum time, and the peak time of pain is 24 hours poatoperation.Though the CO2 gas has some disadvantages, it is superior to other gases. We should shorten the operation time and discharge the CO2 as possible to reduce the absorbability of CO2 when we finish the operation. The stimuli of acid materials such as carbonate that derived from postoperative residual CO2 is the main cause of the pain on the shoulders and epigastrium after the laparoscopicsurgery.