Shoulder Pain is a Common Problem Following Laparoscopic Adjustable Gastric Band Surgery

Australian Centre for Obesity Research and Education, Monash Medical School, The Alfred Hospital, Melbourne, Australia.
Obesity Surgery (Impact Factor: 3.75). 10/2005; 15(8):1111-7. DOI: 10.1381/0960892055002149
Source: PubMed


Shoulder-tip pain is commonly reported following laparoscopic adjustable gastric band (LAGB) placement. The incidence, nature and factors that may increase the risk of pain have not been explored.
A prospective extensive collection of patient characteristics and operative details was obtained from consecutive patients having band placement for severe obesity. Postoperatively, the presence and characteristics of shoulder pain were obtained using a structured interview at discharge from hospital, and at 1 and 5 weeks after placement.
66% and 21% of patients at 1 and 5 weeks respectively following surgery reported pain predominantly in the left shoulder. At 5 weeks, only 7% found the pain of concern and 5% required analgesics. There were no factors found that predicted the presence and severity of pain at 1 week. Injury to the crus of the diaphragm (OR 4.2, 1.4-12.6, P=0.01) and a past history of any upper abdominal surgery (OR 4.2, 1.5-11.7, P=0.007) independently predicted an increased risk of pain at 5 weeks.
Shoulder pain following LAGB surgery is common, usually affects the left shoulder, and can in some cases last 5 weeks or more. Avoiding injury to the crura during the procedure may prevent more prolonged pain.

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    • "38% of patients report constant pain in the 48–72 hrs following surgery, while 28% experience it intermittently. Most patients will require analgesics or nonpharmacologic (heat packs, etc.) treatment for pain relief [3]. "
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    ABSTRACT: Objective. The purpose of this study was to examine the effect of acupuncture on postlaparoscopic shoulder pain (PLSP) which is a common side effect in patients undergoing abdominal laparoscopic surgery. Methods. Patients with moderate to severe PLSP in spite of analgesic treatment, which were referred by the medical staff to the Complementary-Integrative Surgery Service (CISS) at our institution, were provided with acupuncture treatment. The severity of PLSP and of general pain was assessed using a Visual Analogue Scale (VAS) from 0 to 10. Pain assessment was conducted prior to and two hours following acupuncture treatment. Acupuncture treatment was individualized based on traditional Chinese medicine diagnosis. Results. A total of 25 patients were evaluated during a 14-month period, from March 2011 to May 2012. A significant reduction in PLSP (mean reduction of 6.4 ± 2.3 P < 0.0001) and general pain (mean reduction 6.4 ± 2.1 P < 0.0001) were observed, and no significant side effects were reported. Conclusion. Individualized acupuncture treatments according to traditional Chinese medicine principles may improve postlaparoscopic shoulder pain and general pain when used in conjunction with conventional therapy. The primary findings of this study warrant verification in controlled studies.
    Evidence-based Complementary and Alternative Medicine 04/2014; 2014:120486. DOI:10.1155/2014/120486 · 1.88 Impact Factor
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    • "However, laparoscopic procedures are often associated with postlaparoscopic shoulder pain (PLSP), which may cause more discomfort to the patients than the pain at the incision sites 5. The reported incidence of PLSP was 63% after laparoscopic cholecystectomy 6, 66% after laparoscopic adjustable gastric band surgery 7, 65.5% after laparoscopic appendectomy 8 and 83% after gynecological laparoscopic surgeries 5. For improving the postoperative quality of life (QOL) for these patients, various techniques, including low-pressure insufflation, no CO2 insufflation, preemptive diaphragmatic local anesthetic irrigation and regional anesthesia to peritoneal surfaces, have been developed to reduce the PLSP 9-13. "
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    ABSTRACT: The aim of this study was to investigate effect of single- and multiple-dose of parecoxib on shoulder pain after gynecologic laparoscopy. 126 patients requiring elective gynecologic laparoscopy were randomly allocated to three groups. Group M (multiple-dose): receiving parecoxib 40mg at 30min before the end of surgery, at 8 and 20hr after surgery, respectively; Group S (single-dose): receiving parecoxib 40mg at 30min before the end of surgery and normal saline at the corresponding time points; Group C (control): receiving normal saline at the same three time points. The shoulder pain was evaluated, both at rest and with motion, at postoperative 6, 24 and 48hr. The impact of shoulder pain on patients' recovery (activity, mood, walking and sleep) was also evaluated. Meanwhile, rescue analgesics and complications were recorded. The overall incidence of shoulder pain in group M (37.5%) was lower than that in group C (61.9%) (difference=-24.4%; 95% CI: 3.4~45.4%; P=0.023). Whereas, single-dose regimen (61.0%) showed no significant reduction (difference with control=-0.9%; 95% CI: -21.9~20.0%; P=0.931). Moreover, multiple-dose regimen reduced the maximal intensity of shoulder pain and the impact for activity and mood in comparison to the control. Multiple-dose of parecoxib decreased the consumption of rescue analgesics. The complications were similar among all groups and no severe complications were observed. Multiple-, but not single-, dose of parecoxib may attenuate the incidence and intensity of shoulder pain and thereby improve patients' quality of recovery following gynecologic laparoscopy.
    International journal of medical sciences 10/2012; 9(9):757-65. DOI:10.7150/ijms.4916 · 2.00 Impact Factor
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    • "Of the patients with abdominal pain, referred pain to the left shoulder was present, a symptom Dixon et al. [7] reported as an alteration found during the early postoperative period after LAGB placement. Diaphragm injury during surgery has been identified as an independent factor for the development of shoulder pain [7]. We believe that the inflammatory process close to the diaphragm in the case of erosion was responsible for this reported pain in our patients. "
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    ABSTRACT: One of the complications of laparoscopic adjustable gastric banding is intragastric erosion, leading to a revisional procedure to remove the band. Our aim was to present the procedure and results of endoscopic band removal in a 5-year multicenter experience from the Gastro Obeso Center and Universidade de São Paulo, São Paulo, and Universidade Federal de Pernambuco, Recife, Brazil. From 2003 to 2008, 82 patients were diagnosed with band erosion. The clinical data concerning the endoscopic procedure were prospectively recorded and retrospectively reviewed. The average preoperative body mass index was 43.2 kg/m(2) (range 34-50). At the diagnosis of intragastric erosion, the body mass index was 24-41 kg/m(2) (average 31.8). The erosion occurred an average of 16.3 months (range 6-36) postoperatively. The symptoms included pain in 25 (31%), port infection in 21 patients (27%), and weight regain in 20 (25%), and 12 patients (15%) were asymptomatic. Endoscopic removal was possible for 78 patients (95%). In 85% of patients, the band was removed in the first session, with an average duration of 55 minutes (range 25-150). Five cases of pneumoperitoneum occurred after the procedure. Of these, 3 were treated conservatively, 1 was treated by laparoscopy, and 1 was treated by abdominal puncture using the Veress needle. Endoscopic removal of eroded laparoscopic adjustable gastric banding is safe and effective. It can be used as a first choice procedure in clinical practice.
    Surgery for Obesity and Related Diseases 10/2009; 6(4):423-7. DOI:10.1016/j.soard.2009.09.016 · 4.07 Impact Factor
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