title: Shoulder tip pain after laparoscopic surgery analgesia by collateral meridian acupressure (shiatsu) therapy: a report of 2 cases.
abstract: OBJECTIVE
  This article describes 2 cases of collateral meridian acupressure (shiatsu) therapy (CMAT) for treatment of shoulder tip pain after laparoscopic cholecystectomy (LC). Both cases showed marked pain relief with reduction of skin temperature (1 degrees C) of the affected shoulder after CMAT.
  
  
  METHODS
  A 32- and a 53-year-old female presented with right shoulder tip pain after LC surgery. The repeated dose of intravenous ketorolac 30 mg and meperidine 50 mg did not improve the pain. Because of persistent pain and episodes of nausea and vomiting after intravenous nonsteroidal anti-inflammatory drugs and opioid medications, patients refused to take more analgesics, and we were consulted for pain management.
  
  
  RESULTS
  After informed written consent obtained, CMAT was performed using acupoints located on the contralateral (left) kidney meridian to treat affected (right) shoulder pain. Postoperatively, patients' pain intensity was measured using a numeric pain scale. The infrared thermography of shoulder tip was obtained before and after the CMAT. Both patients reported immediate pain relief after the CMAT, with pain scores decreased from 5 to 1 of 10 and 5 to 0 of 10, respectively. Moreover, the local skin temperature of affected shoulders were significantly decreased in both patients after the CMAT. Similarly, the temperature difference between patients' affected and nonpainful shoulders were also significant after the CMAT.
  
  
  CONCLUSIONS
  The results of these 2 cases suggest that the CMAT may be effective in reducing patients' post-LC shoulder tip pain without medication. An associated reduction of skin temperature of the painful shoulder with CMAT warrants further investigation.
authors: Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan.
authors: Chun-Chang
authors: CC
authors: Yeh
authors: Shan-Chi
authors: SC
authors: Ko
authors: Billy K
authors: BK
authors: Huh
authors: Chang-Po
authors: CP
authors: Kuo
authors: Ching-Tang
authors: CT
authors: Wu
authors: Chen-Hwan
authors: CH
authors: Cherng
authors: Chih-Shung
authors: CS
authors: Wong
mesh_terms: D019050:Acupressure; D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D016740:Meridians; D008875:Middle Aged; D010147:Pain Measurement; D020069:Shoulder Pain / Q000209:etiology / Q000628:therapy*; D012881:Skin Temperature