Question
Asked 22nd Oct, 2015

What causes shoulder pain after cesarean section and spinal anesthesia in females?

In my clinic I have noticed that female patients complained from shoulder pain immediately after labor with Cesarean section with spinal anesthesia and this condition may be continuous for several months . no complain during pregnancy, by examination of the shoulder no positive signs presented. x-ray was free.

Most recent answer

10th Nov, 2015
Medhat Maaty
Mansoura University
thank you  Cristian furau for your answer but I am an orthopedic surgeon and this complaint a have faced in my clinic. 

Popular Answers (1)

23rd Oct, 2015
Roop Kishen
The University of Manchester
The above answers are correct. Most common cause (and perhaps the only cause) is the collection of blood, amniotic fluid etc. that drain from uterus during the operation. This collects below the diaphragm and if not carefully prevented from doing so can give rise to pain. However, it should not last for months as you say. Other factors may be involved as clots remaining in situ for a long time. the best thing is to put packs around uterus to prevent the fluid etc. from collection under the diaphragm. However, the very act of placing packs may also cause pain and one has to be careful 
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All Answers (13)

23rd Oct, 2015
Kenichi Takechi
Matsuyama Red Cross Hospital
I think that is referred pain from diaphragm.
Patients usually complain that after peritoneal lavage.
23rd Oct, 2015
Ibrahim Hammad
University of Utah
The pain is most likely a referral pain from the diaphragm. The phrenic nerve passes through the shoulder area and is usually irritated by the air entrapped during the laparotomy.
23rd Oct, 2015
Francisco Javier Soriano-Vidal
Agència Valenciana de Salut
Dear Medhat,
Could be for several reasons, one of those is the Kehr's sign (referred pain). It is the occurrence of acute pain in the tip of the shoulder due to the presence of blood or other irritants in the peritoneal cavity.
Someone else could give other opinions to your question, which would be of great interest.
Yours.
23rd Oct, 2015
Johan Nel
University of the Free State
Irritants in peritoneal cavity, e.g. blood clots, which should have been removed.
Rough surgery may also play a role.
Regards.
23rd Oct, 2015
Sawsan Talib
University of Diyala
most likely  it is referred pain due to irrtation of diaphragm by any irritant in the peretonial cavity like fluid, air or others
23rd Oct, 2015
Roop Kishen
The University of Manchester
The above answers are correct. Most common cause (and perhaps the only cause) is the collection of blood, amniotic fluid etc. that drain from uterus during the operation. This collects below the diaphragm and if not carefully prevented from doing so can give rise to pain. However, it should not last for months as you say. Other factors may be involved as clots remaining in situ for a long time. the best thing is to put packs around uterus to prevent the fluid etc. from collection under the diaphragm. However, the very act of placing packs may also cause pain and one has to be careful 
7 Recommendations
23rd Oct, 2015
Johan Nel
University of the Free State
I agree with Roop Kishen - 2 wet packs alongside the uterus during caesarean section is very helpful to prevent blood from collecting in the upper abdomen. Packs must be inserted and removed gently.
Regards.
1 Recommendation
24th Oct, 2015
Medhat Maaty
Mansoura University
Dear all
thank u very much for your answers
1 Recommendation
29th Oct, 2015
Abdel Karim M. El Hemaly
Al-Azhar University
I agree with most of the answers, however, I may hesitate on amniotic fluid irritating the diaphragm, as to my mind it will be quickly absorded; however air is not easily absorped and it will cause irritation of the diaphragm causing shoulser pain.
30th Oct, 2015
Johan Nel
University of the Free State
I agree with Abdel Hemaly.
3rd Nov, 2015
Khadijeh Kh K Abdali
Shiraz University of Medical Sciences
Distention or any pressure on the  parietal peritoneum could cause severe irritation of the C5nerve ,  one of the causes of this pain is the presence of blood or amniotic fluid in the subdiaphragmatic region                                                                                                            
   maternal hypovolaemia; coagulopathy; infection
at the site of intrathecal catheter or needle insertion; increased
intracranial pressure and patient refusal of regional anaesthesia
 The pain is described as sharp, deep and referred, usually begins intraoperatively and continue for 2-3 days after surgery
9th Nov, 2015
Cristian Furau
„Vasile Goldis” Western University of Arad
Although it has no scientific backup, a difference in the rate of pain appearance can be seen in connection with the horizontalization of the operating table. The more anti Trendelenburg the less number of patients with blood cloths behind the uterus and so a decrease of this type of pain postoperative. Also an appropriate "cleaning" of the peritoneal cavity for blood cloths can diminish the rate.
PS: Do you practice the suture of the uterus inside or outside the abdominal cavity?

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