Effect of Normal Saline Irrigation on Attenuation of Shoulder Tip Pain and on beta-Endorphin Levels After Laparoscopic Cholecystectomy

Abstract

Aim: The purpose of this study was to evaluate the effect of saline washout under the diaphragm on postoperative shoulder tip pain (STP) and beta-endorphin (beta E) levels in patients who had undergone laparoscopic cholecystectomy (LC). Methods: Between December 2010 and March 2011, 50 patients requiring cholecystectomy for benign gallbladder disease were enrolled in this study. Twenty-five patients (Group 1) underwent LC without saline irrigation, whereas the other 25 were operated on with saline irrigation (30mL/kg) under the diaphragm (Group 2). Plasma levels of beta E were measured before and after the operation. The degree of STP following LC was assessed using a visual analog pain scale (VAS) at 6, 12, and 24 hours postoperatively. Results: Eight patients in Group 1 (32.0%) and seven patients in Group 2 (28.0%) complained of STP. There was no significant difference between the two groups in operation time, postoperative hospital length, postoperative beta E, dose of analgesics, or VAS at 6, 12, and 24 hours after surgery. The intensity of abdominal pain (AP) was significantly higher than that of STP. Significantly elevated levels (11.3 +/- 5.1 pg/mL) of beta E were observed postoperatively when compared with preoperative levels (9.7 +/- 5.2 pg/mL) (P=.02). Conclusions: Normal saline irrigation under the diaphragm does not reduce postoperative STP after LC. Ancillary techniques to reduce AP and STP should be considered.