Subphrenic Saline Irrigation for Reducing Postoperative Shoulder Pain after Gynecologic Laparoscopic Surgery: A Randomized Controlled Trial

Objective: To determine the effectiveness of subphrenic saline irrigation for postoperative shoulder pain reduction in gynecologic laparoscopic surgery. Materials and Methods: A randomized controlled trial comparing subphrenic saline irrigation and no irrigation for shoulder pain reduction was conducted at Khon Kaen Hospital between May 1st and August 20th,2014. A total of 62 patients were randomly allocated into two groups: Group A: Subphrenic saline Irrigation (n=31) and Group B: No irrigation (n=31). The primary outcomes were postoperative shoulder pain at 12, 24, and 48 hours, evaluated by using visual analog scale. The secondary outcomes were data of additional analgesics drug use, abdominal discomfort, fever, wound infection and bradycardia. Results: Postoperatively shoulder pain in subphrenic saline irrigation was significantly less than in no irrigation group at 12 hours [median (IQR) 2 (0-3) and 5 (0-6); P= 0.01] and at 24 hours [median (IQR ) 0 (0) and 2 (0-4); P= 0.004]. Abdominal discomfort was significantly higher in the control group [74.2% and 48.4%; P=0.03]. Mean additional analgesic drugs in intervention group was lower than in the control group [2.1±1.5 and 3.6±1.6; P=0.001]. There was no complication. Conclusion: Subphrenic saline irrigation significantly reduced postoperative shoulder pain in gynecologic laparoscopic surgery without serious complications.