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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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