Effect of intraperitoneal fluid instillation at conclusion of gynecologic operative laparoscopy on postoperative shoulder pain

Objective To explore an effective method to prevent the postoperative shoulder pain after gynecologic laparoscopy. [Methods] Ninety-eight patients who underwent laparoscopic surgery in No.1 Gynecologic Ward of Peking University First Hospital from Jun.2004 to Aug.2004 were randomly divided into two groups with 49 cases each. The treatment group received intraperitoneal instillation of 2000 ml fluid, which was drained before suturing of the incision, at the conclusion of operative laparoscopy to assist the evacuation of residual intra-abdominal gas. The control group received traditional method to evacuation of residual intra-abdominal gas. The postoperative shoulder pain was evaluated by visual analog scores (VAS) 6 hours, 1 to 4 days after laparoscopy. [Results] The frequency of shoulder pain was significantly lower in the treatment group (36.7 %)compared with the control group (55.1, P 0.05). Among patients with shoulder pain, the ratio of double-side shoulder pain was also significantly lower in the treatment group (38.9%) compared with the control group(92.6%, P 0.001). The shoulder pain occurred commonly during the first 3 days in both groups. The pain persisted for an average of (1.8±1.3) days in the treatment group and (2.4±1.3) days in the control (P =0.056). The mean VAS score was (2.9±1.4) in the treatment group and (3.3±1.6) in the control (P 0.05). The mean days of hospitalization and recovery to work were similar between the 2 groups. There were no major postoperative complications in either group. The patient satisfaction rates were also similar in the two groups. [Conclusions] Postoperative shoulder pain frequently occurs following laparoscopic surgery. Intraperitoneal fluid instillation at the conclusion of operative laparoscopy to assist the evacuation of residual intra-abdominal gas decreases the the frequency of postoperative shoulder pain.