Kikuchi Chiharu, Tonozaki Shino, Gi Eri, Watanabe Masanori, Shimizu Hitoshi
Department of Anesthesiology, Obihiro-Kyoukai Hospital, Obihiro 080-0805.
Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo 060-8543.
Masui. 2014 Feb;63(2):149-52.
Although shoulder-tip pain during cesarean section has been reported, little is known about this entity. We investigated the incidence of shoulder-tip pain in patients undergoing cesarean delivery under combined spinal-epidural anesthesia (CSEA). Next, we studied whether head-up position during surgery reduced the incidence of shoulder-tip pain due to prevention of the spread of blood and amniotic fluid from the subphrenic space.
Women with ASA physical status I or II undergoing elective or emergency cesarean delivery under CSEA at our hospital were enrolled in this study. In all women, it was investigated whether shoulder-tip pain occurred or not during and after cesarean delivery. In some of the parturient women in this study, 2 to 5 degree head-up position was employed during the operation (head-up group). We compared the frequency of shoulder-tip pain in the head-up group with that in women who were maintained in a horizontal position (horizontal group).
One hundred and twelve of the 242 women recruited to this study experienced shoulder-tip pain. The pain was usually mild to moderate and was relieved in a few days, but 14 patients experienced severe pain as "can not breathe". One hundred and twenty-six of the 160 women lying on an operating table in a head-up position were classified as a head-up group. Shoulder-tip pain was less frequent in the head-up group than horizontal group (50/126 vs. 62/164, P < 0.05).
This study showed that women undergoing cesarean section under CSEA experience shoulder-tip pain with great frequency. Head-up position during surgery decreases shoulder-tip pain during and after cesarean delivery. The results suggest that one of the causes of this pain is the presence of blood or amniotic fluid in the subdiaphragmatic region.
尽管剖宫产术中肩峰下疼痛已有报道，但对此情况仍知之甚少。我们调查了在腰麻-硬膜外联合麻醉（CSEA）下行剖宫产的患者中肩峰下疼痛的发生率。接下来，我们研究了手术中头高位是否因防止血液和羊水从膈下间隙扩散而降低了肩峰下疼痛的发生率。
本研究纳入了在我院接受CSEA下择期或急诊剖宫产的ASA身体状况为I或II级的女性。所有女性均被调查剖宫产术中及术后是否发生肩峰下疼痛。在本研究的部分产妇中，手术期间采用2至5度头高位（头高位组）。我们将头高位组肩峰下疼痛的发生率与保持水平位的女性（水平位组）进行了比较。
本研究招募的242名女性中有112名经历了肩峰下疼痛。疼痛通常为轻至中度，数天内缓解，但有14名患者经历了“无法呼吸”的严重疼痛。160名头高位躺在手术台上的女性中有126名被归类为头高位组。头高位组肩峰下疼痛的发生率低于水平位组（50/126 vs. 62/164，P < 0.05）。
本研究表明，在CSEA下行剖宫产的女性中肩峰下疼痛发生率很高。手术中头高位可降低剖宫产术中及术后的肩峰下疼痛。结果表明，这种疼痛的原因之一是膈下区域存在血液或羊水。
