Partida-Márquez Antonio Luis, Fernández-Domínguez Juan Carlos, Martínez-Fernández José Antonio, Pabón-Carrasco Manuel, Melero-Cortes Lidia, Oliva-Pascual-Vaca Ángel
Red Cross University Nursing Centre, University of Seville, Seville, Spain.
Department of Gynecology, Virgen del Rocío University Hospital, Seville, Spain.
Surg Endosc. 2025 Aug 18. doi: 10.1007/s00464-025-12077-6.
Referred cervicoscapular pain is common after laparoscopic surgery. This pain has different characteristics from incisional pain and requires a different approach.
A blinded, randomized, controlled trial was conducted. Women reporting referred pain with an intensity of 7 points or higher on the visual analogue scale after total laparoscopic hysterectomy (TLH) were randomly assigned to a diaphragmatic breathing group (DBG) or a neck exercise group (NEG). Both groups performed the exercises three times daily, and the usual medical care was maintained. Pain intensity and location were assessed using the McGill questionnaire. Specific self-reported questionnaires were used to assess the evolution of functional disability in the head (HIT-6), shoulder and neck (NDI), or upper limbs (QuickDASH). Follow-up was conducted weekly for 4 weeks after surgery.
Seventy-four women (43.7 ± 9,5 years; 26.6 ± 4.9 body mass index) were recruited. The most common area of referred pain was the shoulder and neck (n = 55), followed by the head (n = 48) and upper limbs (n = 14), with four women showing pain in all three areas and thirty-five in two areas. Both groups showed improvement over time in pain intensity and functional disability in all the locations (p < 0,001). However, DBG demonstrated a faster recovery for pain intensity, NDI, and HIT-6 (p < 0,001), while no between-group difference was found for QuickDASH (p > 0,05). No adverse effects were reported for any of the tested interventions.
Referred pain in TLH tends to become self-limiting over time, but diaphragmatic breathing exercises resulted in a faster reduction in pain intensity and craniocervical disability when compared with gentle cervical stretching exercises. Thus, abdominodiaphragmatic breathing might be a simple and safe complementary intervention to be taught to patients suffering from referred pain after TLH.
腹腔镜手术后出现的颈肩牵涉痛很常见。这种疼痛与切口疼痛具有不同的特征，需要不同的处理方法。
进行了一项双盲、随机、对照试验。在全腹腔镜子宫切除术后视觉模拟量表上报告牵涉痛强度为7分或更高的女性被随机分配到膈肌呼吸组（DBG）或颈部运动组（NEG）。两组均每天进行三次练习，并维持常规医疗护理。使用麦吉尔问卷评估疼痛强度和部位。使用特定的自我报告问卷评估头部（HIT-6）、肩部和颈部（NDI）或上肢（QuickDASH）功能障碍的演变。术后每周随访4周。
招募了74名女性（年龄43.7±9.5岁；体重指数26.6±4.9）。牵涉痛最常见的部位是肩部和颈部（n = 55），其次是头部（n = 48）和上肢（n = 14），4名女性在所有三个部位都有疼痛，35名女性在两个部位有疼痛。两组在所有部位的疼痛强度和功能障碍随时间均有改善（p < 0.001）。然而，DBG在疼痛强度、NDI和HIT-6方面恢复更快（p < 0.001），而QuickDASH在组间未发现差异（p > 0.05）。未报告任何测试干预措施有不良反应。
全腹腔镜子宫切除术后的牵涉痛往往会随着时间的推移而自行缓解，但与轻柔的颈部伸展运动相比，膈肌呼吸练习能更快地减轻疼痛强度和颅颈功能障碍。因此，腹式膈肌呼吸可能是一种简单安全的辅助干预措施，可教给全腹腔镜子宫切除术后出现牵涉痛的患者。
