The Influence Of Laparoscopic And Open Gynecological Surgery On Postoperative Shoulder Pain

Objective Laparoscopic techniques made surgery field into a minimally invasive era. With the techniques’ widely use, postoperative shoulder pain which is the main non-surgical site pain after surgery has gradually caused surgeon’s attention. The mechanism of postoperative shoulder pain hasn’t been clarified thoroughly, but existing research suggests that postoperative shoulder pain is mainly related to artificial pneumoperitoneum. Along with the increase in related researches, postoperative shoulder pain can be observed after gasless laparoscopic surgery. It’s been explained in some research that shoulder pain after gasless laparoscopic surgery is caused by the traction of the abdominal wall which irritate the diaphragm muscle. This study is aimed to observe the incidence, severity and duration of shoulder pain after gynecological laparoscopic surgery and open surgery, make a comparison between the two groups, and make sure whether the postoperative shoulder pain affect the postoperative recovery. So as to make it clear whether postoperative shoulder pain occurs after open operation, and elaborate characteristics of postoperative shoulder pain, and provide theoretical basis for further study to explore the mechanism and new treatment of postoperative shoulder pain.Methods After the study approved by the ethics committee at our institution, the patients who had undergone a scheduled gynecologic surgery, lasting one to three hours, between Dec 1,2013 and May 31,2014 at our hospital were included sequentially. Before the research, all patients were informed and gave oral informed consent. Those who were not in accordance with the inclusion criteria or met one of the exclusion criteria were excluded from the study. The research collected every participant’s baseline information which included name, admission number, age, height, weight, medical and surgical history. And they were evaluated at the 2,12, 24,48 and 72 hours after surgery. The main target was to record the incidence, severity, appearance and remission time of postoperative shoulder pain and surgical site pain severity which was accessed using a Numerical Rating Scale (NRS) from 0 to 10. The research also recorded whether the patients used the PCIA for postoperative analgesia, the incidence of PONV and their postoperative recovery indicators which included the first postoperative flatus time and postoperative hospitalization duration. The duration of analgesia, operation and pneumoperitoneum, and PACU stay were inquired though anesthetic records. Statistical analysis The patients were divided into two groups according to the surgical method. Epidata 3.1 (Epidata Inc, Denmark) and SPSS 17.0 (SPSS Inc, USA) were used for data record and analysis. The quantified data were expressed by mean±standard deviation. If the data conformed to the normal distribution, independent-sample t-tests were used to compare the differences between two groups, or Mann-Whitney U tests were used. Corrected repetitive measurement deviation analysis was used for repeated measurement data. The enumeration data were expressed by sample size and percentage. The chi-square tests or Fisher probabilities were used for comparison of enumeration data. Multivariable Logistic regression analysis was used for the baseline information. All tests were two-tailed, and the level of significance was 0.05.Results 201 qualified patients’data were collected, which included 97 laparoscopic surgery and 104 open surgery. The incidence of shoulder pain in group L (Laparoscopic surgery group) (33.0%) was higher than group O(Open surgery group)(11.5%) (P<0.01), and the incidence of those who suffered more serious shoulder pain than surgical site pain were separately 14.4% and 4.8%. The shoulder pain was mild-to-moderate, but the severity was no significant statistical difference between two groups. Postlaparoscopic shoulder pain mainly appeared within 12h or 24h after surgery, and relieved beyond 24h,48h or 72h after surgery. The surgical site pain scores in group L was less than group O, separatively in 2h(resting, P<0.01),12h(resting, P<0.05),72h(active, P<0.01) after surgery. The usage of PCIA, PACU stay, the first postoperative flatus time, and postoperative hospital day were less than group O(P<0.01). In the laparoscopic group, there were no statistical difference in the first flatus time and postoperative hospital stay between shoulder pain group and non-shoulder pain group. But the shoulder pain group had longer operative time than non-shoulder pam group.Conclusion Shoulder pain can be observed after open surgery and laparoscopic surgery, but laparoscopic surgery has higher incidence than open surgery. Postoperative shoulder pain is mild-to-moderate, and the severity may be affected by pneumoperitoneum duration. The shoulder pain lasts from 12 hours to 72 hours after the surgery. The postoperative shoulder pain doesn’t affect the postoperative recovery time.