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腹腔镜术后肩部疼痛的管理:一项叙述性综述

Post-laparoscopic Shoulder Pain Management: A Narrative Review.

作者信息

Zhao Yan, Xin Wen, Luo Xiaohui

机构信息

Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, People's Republic of China.

出版信息

Curr Pain Headache Rep. 2025 Jan 8;29(1):18. doi: 10.1007/s11916-024-01355-y.

Abstract

PURPOSE OF REVIEW

Post-laparoscopic shoulder pain (PLSP) can slow patient recovery and extend hospital stays, making its management crucial for patients undergoing laparoscopic surgery. Current consensus guidelines say little about how to prevent or manage PLSP. In this context, a multimodal approach to PLSP management that maybe extend beyond the pharmaceutical interventions currently employed. A variety of devices comprising both invasive and noninvasive approaches are available to patients, serving as adjuvants to analgesics. In this review, we explore the potential causes of PLSP. Additionally, by searching relevant databases and reviewing existing literature, we provide a comprehensive summary of current PLSP management strategies excluding analgesics.

RECENT FINDINGS

A total of 30 articles were reviewed. The review identified a number of different treatments for PLSP, including trendelenburg position, discharge of residual gas, pulmonary recruitment manoeuvre, low-pressure pneumoperitoneum and phrenic nerve block, among others. However, the inconsistencies in the study designs resulted in disparate conclusions. While the current studies provide valuable insights, there is a clear need for further research in this area.

摘要

综述目的

腹腔镜术后肩部疼痛(PLSP)会延缓患者康复并延长住院时间,因此对接受腹腔镜手术的患者而言,其管理至关重要。目前的共识指南对如何预防或处理PLSP提及甚少。在此背景下,一种多模式的PLSP管理方法可能会超出目前所采用的药物干预范围。患者可使用多种包括有创和无创方法的设备,作为镇痛药的辅助手段。在本综述中,我们探讨了PLSP的潜在原因。此外,通过检索相关数据库并回顾现有文献,我们对目前不包括镇痛药在内的PLSP管理策略进行了全面总结。

最新发现

共回顾了30篇文章。该综述确定了多种针对PLSP的不同治疗方法,包括头低脚高位、排出残余气体、肺复张手法、低压气腹和膈神经阻滞等。然而,研究设计的不一致导致了不同的结论。虽然目前的研究提供了有价值的见解,但该领域显然仍需要进一步研究。

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The Impact of Incentive Spirometry on Shoulder Tip Pain in Laparoscopic Cholecystectomy: A Randomized Clinical Trial.
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