Laparoscopic surgery is a minimally invasive surgical diagnostic procedure that is used to examine organs inside the abdomen.
In laparoscopy, carbon dioxide gas is injected near the abdomen and belly button to create a space between the abdomen and the internal organs. This space created will allow the surgeon to have a better view of the internal organs. The carbon dioxide gas, however, poses a risk to the patient as it causes an irritation in the nerves and it affects the physiology of the surrounding peritoneal tissue when it gets trapped against the diaphragm. A few days after a laparoscopic surgery, the patient may feel discomfort and pain that might result in irritation of the nerve endings in the diaphragm which can lead to referred pain the shoulder.
Treatment of Shoulder Pain after Laparoscopic Surgery
- Application of heat
Use heating pads and apply on the part of the shoulder where you are experiencing pain. Use one on the front and the other one on the back of the affected shoulder.
- Pain medications
You can take pain medications to help reduce the pain. Be sure to consult your doctor before taking any pain medication for the referred shoulder pain.
- Anti-inflammatory analgesics
A doctor may also prescribe analgesics to reduce the shoulder pain. The analgesics depend on the intensity of the pain experienced by the patient. Anti-inflammatory analgesics can help reduce the pain caused by the inflammation of the peritoneal reflections that the phrenic nerve supplies.
- Natural home remedies
Natural home remedies that can easily be found or prepared at home can also be taken to alleviate the pain and to help dissipate the gas. You can try drinking peppermint tea, carrot juice, or ginger ale.
- Lie down flat
The trapped carbon dioxide gas in the intestine is the type of gas that rises so when you are sitting down or are on your feet, the gas goes up to the shoulder area. Laying down flat will allow the gas to go down to the abdominal area so you won playing down flat or on your side may help the trapped carbon dioxide gas leave the abdomen. When laying down, try to do it slowly because when you hurry and lay down too fast in bed, it may trigger the shoulder pain all the more.
- Use Pillows
Laying with your back against pillows while on the couch and laying down with your legs elevated in two huge pillows under your knees can help reduce the shoulder pain.
- Agarwala Maneuver
Air Gas Active Removal with Above the Liver Aspiration Maneuver that is usually performed before closing the ports can help alleviate the shoulder pain caused by laparoscopic surgery. In this procedure, the carbon dioxide gas that is trapped in the abdomen is suctioned by putting the irrigation suction on top of the liver and removing the carbon dioxide until the abdomen is completely desufflated.
- Lignocaine or bupivacaine
Lignocaine is a local anesthetic and anti-arrhythmic drug to help reduce the pain. Bupivacaine is another anesthetic medication that decreases the feeling in a certain area. Bupivacaine works by blocking the nerve impulses that send pain signals to the brain
- Intraperitoneal drainage
Intraperitoneal drainage is the draining of the excess fluid or in this case, carbon dioxide gas, from the abdomen.
- Intraperitoneal normal saline infusion
In this procedure, the abdominal cavity’s upper part is bilaterally and evenly filled with normal saline and the fluid is left in the abdominal cavity.
- Placebo comparator
Passive exsufflation is used to remove trapped carbon dioxide gas through the port site.
Massaging the area in the shoulder where the pain is felt can help reduce the shoulder pain.
- Pulmonary recruitment maneuver
A recruitment maneuver is a voluntary strategy to increase the transpulmonary pressure to reopen the alveolar units that are poorly aerated or not aerated but can be opened again. This can be used to reduce the severity and incidence of shoulder pain.
Insuflow is an easy-to-use laparoscopic gas conditioning device that produces the best conditions in performing laparoscopic surgery. Insuflow is compatible with all kinds of insufflators and is used by many surgery centers and hospitals in the US for more than 10 years. Insuflow works by adding warmth and humidity to the carbon dioxide gas that is being injected into the abdomen which creates a balanced operating environment within the peritoneal cavity which decreases damage to the peritoneum.
These are the following benefits of using Insuflow with laparoscopic surgery:
- Less post-operative pain
- Less narcotic pain medication
- Reduced hypothermia and shivering
- Less nausea
- Improved outcomes
- Improved visualization
- Faster recovery times
- Less damage to tissues resulting in reduced inflammatory response
The shoulder pain after a laparoscopic surgery should only last up to 48 to 72 hours after the surgery. If the shoulder pain gets worse or does not go away after 72 hours and even after taking pain meds, analgesics, and going for natural home remedies, immediately contact your surgeon to address the post laparoscopic surgery pain.