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Suprascapular nerve block or a piroxicam patch for shoulder tip pain after day case laparoscopic surgery

Published online by Cambridge University Press:  02 June 2005

J. Y. Hong  and
I. H. Lee
J. Y. Hong
Affiliation:
Sungkyunkwan University School of Medicine, Department of Anesthesiology, Samsung Cheil Hospital, Seoul, South Korea
I. H. Lee
Affiliation:
Sungkyunkwan University School of Medicine, Department of Anesthesiology, Samsung Cheil Hospital, Seoul, South Korea
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Extract

Summary

Background and objective: The reported incidence of shoulder tip pain following laparoscopic surgery varies from 35 to 63%. This study evaluated the analgesic efficacy of either performing a prophylactic suprascapular nerve block with bupivacaine or applying a piroxicam patch to the skin over both shoulders for the relief of shoulder tip pain after laparoscopy.

Methods: Sixty healthy informed female patients were randomly assigned to one of three groups: (a) a control group (n = 20), no treatment; (b) a suprascapular nerve block group (n = 20) in which a bilateral suprascapular nerve block was performed before induction of anaesthesia with 5 mL 0.5% bupivacaine with epinephrine; and (c) a piroxicam patch group (n = 20) in which a 48 mg piroxicam patch on the skin of each shoulder was applied before induction of anaesthesia. All patients received a total intravenous anaesthesia technique with propofol, fentanyl and vecuronium. Shoulder tip and wound pain were recorded on a visual analogue pain scale at five time intervals for 24 h after surgery.

Results: A total of 80% of patients in the control group, 75% in the suprascapular nerve block group and 45% in the piroxicam patch group complained of shoulder tip pain during the recording period (P < 0.05). The scores for shoulder tip pain in the piroxicam patch group were significantly lower compared with the control group at 3, 6 and 12 h, and compared with the suprascapular nerve block group at 6 and 12 h. The need for analgesics was also significantly lower in the piroxicam patch group compared with the other two groups.

Conclusions: Prophylactic piroxicam patches are effective and safe for the relief of shoulder tip pain after laparoscopy. Bilateral suprascapular nerve block is not effective in this setting.

Keywords

ANAESTHESIA CONDUCTION, nerve blockANAESTHETICS, localbupivacaineANALGESICS, NON-NARCOTIC, anti-inflammatory agents, non-steroidalpiroxicamPAIN, POSTOPERATIVEPAIN, shoulder pain
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 3 , March 2003 , pp. 234 - 238
Copyright
© 2003 European Society of Anaesthesiology

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References

Dobbs FF, Kumar V, Alexander JI, Hull MGR. Pain after laparoscopy related to posture and ring versus clip sterilization. Br J Obstet Gynecol 1987; 94: 262–266.Google Scholar
Fraser RA, Hotz SB, Hurtig JB, Hodges SN, Moher D. The prevalence and impact of pain after day-care tubal ligation surgery. Pain 1989; 30: 189–201.Google Scholar
Jorgensen JO, Gillies RB, Hunt DR, Caplehorn JRM, Lumley T. A simple and effective way to reduce postoperative pain after laparoscopic cholecystectomy. Aust NZ J Surg 1995; 65: 466–469.Google Scholar
Loughney AD, Scarma V, Ryall EA. Intraperitoneal bupivacaine for the relief of pain following day-case laparoscopy. Br J Obstet Gynecol 1994; 101: 449–451.Google Scholar
Kelly MC. An assessment of the value of intraperitoneal bupivacaine for analgesia after laparoscopic sterilisation. Br J Obstet Gynecol 1996; 103: 837–839.Google Scholar
Moore DC. Block of the suprascapular nerve. In: Moore DC, ed. Regional Block: A Handbook for Use in the Clinical Practice of Medicine and Surgery, 4th edn. Springfield, IL, USA: Charles C. Thomas, 1979: 300–303.
Emery P. Suprascapular nerve block for chronic shoulder pain in rheumatoid arthritis. BMJ 1989; 299: 1079–1080.Google Scholar
Meyer-Witting M. Suprascapular nerve block in the management of cancer pain. Anaesthesia 1992; 47: 626.Google Scholar
Wassef MR. Suprascapular nerve block: a new approach for the management of frozen shoulder. Anaesthesia 1992; 47: 120–124.Google Scholar
Ritchie ED, Tong D, Chung F, et al. Suprascapular nerve block for postoperative pain relief in arthroscopic shoulder surgery: a new modality? Anesth Analg 1997; 84: 1306–1312.Google Scholar
Jackson SA, Laurence AS, Hill JC. Does post-laparoscopy pain relate to residual carbon dioxide? Anaesthesia 1996; 51: 485–487.Google Scholar
Perry CP, Tombrello R. Effect of fluid instillation on postlaparoscopic pain. J Reprod Med 1993; 38: 768–770.Google Scholar
Riedel HH, Semm K. The post-laparoscopic pain syndrome. Geburtshilfe Frauenheilkd 1980; 40: 635–643.Google Scholar
Korell M, Schmaus F, Strowitzki T, Schneeweiss SG, Hepp H. Pain intensity following laparoscopy. Surg Laparosc Endosc 1996; 6: 375–379.Google Scholar
Cordero JA, Alarcon L, Escribano E, Obach R, Domenech J. A comparative study of the transdermal penetration of a series of nonsteroidal anti-inflammatory drugs. J Pharm Sci 1997; 86: 503–508.Google Scholar
Kirsch I. Changing Expectations: A Key to Effective Psychotherapy. Pacific Grove, CA, USA: Brooks Cole, 1990: 1–197.