The Intensity of Postlaparoscopic Shoulder Pain Is Positively Correlated with the Amount of Residual Pneumoperitoneum

Study Objective Residual carbon dioxide, which is inevitably retained in the abdominal cavity after laparoscopy, plays an important role in inducing postlaparoscopic shoulder pain (PLSP). The aim of this study was to determine the relationship between the volume of a residual pneumoperitoneum and the intensity of PLSP. Design A prospective cohort study (Canadian Task Force classification II-2). Setting A university hospital. Patients A total of 203 patients undergoing laparoscopy for nonmalignant gynecologic diseases. Interventions Gynecologic laparoscopy. Main Outcome Measures The volume of the residual pneumoperitoneum was measured by performing chest radiography 24 hours after surgery. The pneumoperitoneum was graded as high volume (defined as ≥the median volume of the pneumoperitoneum) and low volume (defined as <the median volume). Perioperative data including PLSP intensity scores were collected. Results The median volume of the residual pneumoperitoneum was 17.0 mL (0.5–133.8 mL). The intensity of PLSP was significantly higher in the high-volume group compared with the low-volume group (p <.001). A lower volume of the pneumoperitoneum was associated with less analgesic requirement (p =.032), a shorter hospitalization period (p =.007), and higher satisfaction from the surgery (p =.005). The residual gas volume and PLSP score exhibited a positive correlation that was statistically significant (r = 0.735, p <.001). Conclusion The volume of the residual pneumoperitoneum was positively correlated with the intensity of shoulder pain after laparoscopy. Therefore, surgeons should release as much gas as possible from the peritoneal cavity at the end of laparoscopy.