Intraperitoneal Saline Instillation in Reducing Shoulder Tip Pain after Laparoscopic Surgeries

Introduction: The incidence of shoulder pain after laparoscopic surgery ranges from 35 to 80%. Objectives: The objective of the study was to find the proportion of shoulder tip pain after laparoscopic surgeries with and without intraperitoneal subdiaphragmatic saline instillation and to compare the frequency of post-operative analgesics usage in both groups. Methods: A longitudinal comparative study was conducted on 56 patients undergoing laparoscopic surgeries. Twenty-eight subjects in the study group received intraperitoneal subdiaphragmatic saline wash at the end of the procedure and the control group received no wash. Post-operative shoulder pain was assessed by a visual analogue scale at fixed time intervals. Post-operative use of analgesics, length of stay in the hospital and early mobilisation and discharge from the hospital were also considered. Results and Discussion: Among the 56 patients, there was a statistically significant reduction in the shoulder tip pain postoperatively at 6, 12, 24 and 48 h. Additional analgesic requirement was less in the Wash group, statistically significant at 6, 12, 24 and 48 h post surgery. This significance in outcome was also reflected in the length of the hospital stay, smooth recovery, early discharge, better quality of life and early return to work. Conclusion: Intraperitoneal subdiaphragmatic normal saline wash significantly improved the surgical outcome after laparoscopic surgery by diminishing the shoulder tip pain, minimising analgesic requirements in the post-operative period, thus enhancing early mobilisation and discharge.