title: Effect of normal saline irrigation on attenuation of shoulder tip pain and on β-endorphin levels after laparoscopic cholecystectomy.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the effect of saline washout under the diaphragm on postoperative shoulder tip pain (STP) and β-endorphin (βE) levels in patients who had undergone laparoscopic cholecystectomy (LC).
  
  
  METHODS
  Between December 2010 and March 2011, 50 patients requiring cholecystectomy for benign gallbladder disease were enrolled in this study. Twenty-five patients (Group 1) underwent LC without saline irrigation, whereas the other 25 were operated on with saline irrigation (30 mL/kg) under the diaphragm (Group 2). Plasma levels of βE were measured before and after the operation. The degree of STP following LC was assessed using a visual analog pain scale (VAS) at 6, 12, and 24 hours postoperatively.
  
  
  RESULTS
  Eight patients in Group 1 (32.0%) and seven patients in Group 2 (28.0%) complained of STP. There was no significant difference between the two groups in operation time, postoperative hospital length, postoperative βE, dose of analgesics, or VAS at 6, 12, and 24 hours after surgery. The intensity of abdominal pain (AP) was significantly higher than that of STP. Significantly elevated levels (11.3±5.1 pg/mL) of βE were observed postoperatively when compared with preoperative levels (9.7±5.2 pg/mL) (P=.02).
  
  
  CONCLUSIONS
  Normal saline irrigation under the diaphragm does not reduce postoperative STP after LC. Ancillary techniques to reduce AP and STP should be considered.
authors.affiliation: Department of Anatomy and Cell Biology, College of Medicine, Hanyang University, Seoul, Korea.
authors.forename: Youn Kyoung
authors.initials: YK
authors.lastname: Seo
authors.forename: Hee Jong
authors.initials: HJ
authors.lastname: Lee
authors.forename: Tae Kyung
authors.initials: TK
authors.lastname: Ha
authors.forename: Kyeong Geun
authors.initials: KG
authors.lastname: Lee
mesh_terms: D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000379:methods*; D002764:Cholecystitis / Q000150:complications / Q000601:surgery; D002769:Cholelithiasis / Q000150:complications / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control*; D011028:Pneumoperitoneum, Artificial; D020069:Shoulder Pain / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism / Q000628:therapy*; D012965:Sodium Chloride / Q000008:administration & dosage*; D007507:Therapeutic Irrigation; D001615:beta-Endorphin / Q000378:metabolism*
chemical_list: D012965:Sodium Chloride; D001615:beta-Endorphin