Pier A, Benedic M, Mann B, Buck V
Abteilung für Laparoskopische Chirurgie, Kreiskrankenhaus Grevenbroich.
Chirurg. 1994 Mar;65(3):200-8.
The so-called post-laparoscopic algesia is a specific impairment of about 63% of the patients who undergo laparoscopic surgical operations. This impairment takes the form of mild to moderate shoulder pain. Eliminating the causes of pain has a clear advantage over symptomatic treatment using analgetics, a fact worth a good consideration especially with the post-operative sojourn at the hospital becoming shorter and shorter. In a prospective controlled study, involving 42 patients subdivided into four groups namely, higher or lower insufflation pressures, chemically inert insufflation gas and control groups; the use of analgetics, lung function, operation duration, amount of insufflated gas, intraperitoneal pH-values and post-operative complications in the various subgroups were compared to each other with regard to post-operative pain perception. The results did not show any significant differences among the groups regarding the main parameters like pH-value or different insufflation pressures etc. These results led to the termination of the study based on the raised criteria since we anticipated the actual cause of the shoulder pain to be due to an unknown factor. By the evaluation of the individual data, it became apparent that, the pains increase with increasing gas consumption, a fact which led to assumption that the pains are caused by a physical effect such as the cooling of the peritoneum.
所谓的腹腔镜术后疼痛是约63%接受腹腔镜手术患者的一种特定损伤。这种损伤表现为轻至中度的肩部疼痛。消除疼痛原因比使用镇痛药进行对症治疗具有明显优势，尤其考虑到患者术后在医院的停留时间越来越短，这一事实值得认真思考。在一项前瞻性对照研究中，42名患者被分为四组，即不同的气腹压力组、化学惰性气腹气体组和对照组；就术后疼痛感知而言，比较了各亚组中镇痛药的使用情况、肺功能、手术持续时间、气腹气体量、腹腔内pH值及术后并发症。在诸如pH值或不同气腹压力等主要参数方面，各组结果未显示出任何显著差异。由于预计肩部疼痛的实际原因是某个未知因素，基于提高的标准，这些结果导致研究终止。通过对个体数据的评估，很明显疼痛随着气体消耗量的增加而加剧，这一事实使人认为疼痛是由诸如腹膜冷却等物理效应引起的。
