title: [Shoulder-tip pain during cesarean section under combined spinal-epidural anesthesia].
abstract: BACKGROUND
  Although shoulder-tip pain during cesarean section has been reported, little is known about this entity. We investigated the incidence of shoulder-tip pain in patients undergoing cesarean delivery under combined spinal-epidural anesthesia (CSEA). Next, we studied whether head-up position during surgery reduced the incidence of shoulder-tip pain due to prevention of the spread of blood and amniotic fluid from the subphrenic space.
  
  
  METHODS
  Women with ASA physical status I or II undergoing elective or emergency cesarean delivery under CSEA at our hospital were enrolled in this study. In all women, it was investigated whether shoulder-tip pain occurred or not during and after cesarean delivery. In some of the parturient women in this study, 2 to 5 degree head-up position was employed during the operation (head-up group). We compared the frequency of shoulder-tip pain in the head-up group with that in women who were maintained in a horizontal position (horizontal group).
  
  
  RESULTS
  One hundred and twelve of the 242 women recruited to this study experienced shoulder-tip pain. The pain was usually mild to moderate and was relieved in a few days, but 14 patients experienced severe pain as "can not breathe". One hundred and twenty-six of the 160 women lying on an operating table in a head-up position were classified as a head-up group. Shoulder-tip pain was less frequent in the head-up group than horizontal group (50/126 vs. 62/164, P < 0.05).
  
  
  CONCLUSIONS
  This study showed that women undergoing cesarean section under CSEA experience shoulder-tip pain with great frequency. Head-up position during surgery decreases shoulder-tip pain during and after cesarean delivery. The results suggest that one of the causes of this pain is the presence of blood or amniotic fluid in the subdiaphragmatic region.
authors.affiliation: Department of Anesthesiology, Obihiro-Kyoukai Hospital, Obihiro 080-0805.
authors.forename: Chiharu
authors.initials: C
authors.lastname: Kikuchi
authors.affiliation: Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo 060-8543.
authors.forename: Shino
authors.initials: S
authors.lastname: Tonozaki
authors.affiliation: Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo 060-8543.
authors.forename: Eri
authors.initials: E
authors.lastname: Gi
authors.affiliation: Department of Anesthesiology, Oji General Hospital, Tomakomai 053-8506.
authors.forename: Masanori
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: Department of Anesthesiology, JR Sapporo Medical Hospital, Sapporo 060-0033.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Shimizu
mesh_terms: D000328:Adult; D000653:Amniotic Fluid; D000767:Anesthesia, Epidural; D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal; D002585:Cesarean Section; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology* / Q000517:prevention & control*; D056888:Patient Positioning; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control*; D011187:Posture / Q000502:physiology*; D011247:Pregnancy; D012039:Regional Blood Flow; D020069:Shoulder Pain / Q000209:etiology* / Q000517:prevention & control*