Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea.
Surg Endosc. 2018 Jan;32(1):160-165. doi: 10.1007/s00464-017-5651-5. Epub 2017 Jun 22.
To determine the incidence, natural course, and specific characteristics of postlaparoscopic shoulder pain (PLSP).
The prospective study included 105 patients undergoing laparoscopy for benign gynecologic diseases. The intensity of pain, and the identification of the pain site, was assessed 24- and 48-h after surgery, using a visual analogue scale. The description and intensity of PLSP, its aggravating and relieving factors, and the response to analgesics were assessed over a 1-week period using a self-reported questionnaire.
Of 105 patients, 84 (80%) experienced PLSP. PLSP along with wound pain peaked one day after surgery, gradually subsided, and were not reported by the seventh day after surgery. Of the 84 patients experiencing PLSP, 77 (91.7%) had aggravating and relieving factors, which included position change (48.8%) and rest (42.9%), respectively. Analgesics provided significantly less pain relief for PLSP (32.7 ± 32.2%), when compared to relief of wound pain (68.0 ± 16.2%) (P < 0.001).
PLSP, identified in 80% of our patients, resolved in most patients within the first week after laparoscopy. Since PLSP is less responsive to analgesics, when compared to wound pain, surgeons should pay attention to the prevention of PLSP among patients undergoing laparoscopy.
确定腹腔镜术后肩部疼痛（PLSP）的发生率、自然病程和具体特征。
前瞻性研究纳入了 105 例行腹腔镜治疗良性妇科疾病的患者。术后 24 小时和 48 小时，使用视觉模拟评分法评估疼痛强度和疼痛部位，并通过自我报告问卷评估 PLSP 的描述、强度、加重和缓解因素以及对镇痛药的反应，为期一周。
105 例患者中，84 例（80%）出现 PLSP。PLSP 伴切口疼痛在术后一天达到高峰，逐渐缓解，术后第 7 天不再报告。在出现 PLSP 的 84 例患者中，77 例（91.7%）有加重和缓解因素，分别为体位改变（48.8%）和休息（42.9%）。镇痛药对 PLSP 的止痛效果明显低于切口疼痛（32.7±32.2%对 68.0±16.2%）（P<0.001）。
我们的患者中有 80%出现了 PLSP，大多数患者在腹腔镜术后一周内缓解。由于 PLSP 对镇痛药的反应不如切口疼痛，因此外科医生应注意预防腹腔镜术后肩部疼痛。
