title: Effect of ultrasound-guided phrenic nerve block on shoulder pain after laparoscopic cholecystectomy-a prospective, randomized controlled trial.
abstract: Post-laparoscopic shoulder pain (PLSP) frequently follows a laparoscopic cholecystectomy. A proposed mechanism for PLSP is the irritation or injury of the phrenic nerve by the CO2pneumoperitoneum during laparoscopic surgery. Here, we investigated whether a phrenic nerve block (PNB), performed under ultrasound guidance, could reduce the incidence and severity of PLSP after laparoscopic cholecystectomy.
  
  
  
  Sixty patients were randomized into two groups, with one group receiving PNB with 4 ml (30 mg) of 0.75% ropivacaine (group P, n = 28) and a control group (group C, n = 32). The existence and severity of PLSP were assessed for 2 days postoperatively. A pulmonary function test (PFT) and diaphragmatic excursion test were performed pre- and postoperatively.
  
  
  
  With ultrasound guidance, all PNBs were performed successfully in group P. In group P, the overall incidence and severity of PLSP decreased significantly. There were no significant differences in incisional pain, visceral pain, and analgesic requirements between the groups. Right-side diaphragmatic excursion decreased significantly in group P at 1 h postoperatively. The PFT results and respiratory discomfort assessed by a modified Borg's scale were not different significantly between the groups.
  
  
  
  Based on these findings, ultrasound-guided PNB can prevent or reduce the PLSP without clinically significant respiratory discomfort.
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Chung-Ang University Hospital, 224-1 Heukseok-dong, Dongjak-gu, Seoul, 156-755, Republic of Korea.
authors.forename: Myung Sub
authors.initials: MS
authors.lastname: Yi
authors.affiliation: Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, Republic of Korea.
authors.forename: Won Joong
authors.initials: WJ
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Chung-Ang University Hospital, 224-1 Heukseok-dong, Dongjak-gu, Seoul, 156-755, Republic of Korea.
authors.forename: Min Kyoung
authors.initials: MK
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Chung-Ang University Hospital, 224-1 Heukseok-dong, Dongjak-gu, Seoul, 156-755, Republic of Korea.
authors.forename: Hyun
authors.initials: H
authors.lastname: Kang
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Chung-Ang University Hospital, 224-1 Heukseok-dong, Dongjak-gu, Seoul, 156-755, Republic of Korea.
authors.forename: Yong-Hee
authors.initials: YH
authors.lastname: Park
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Chung-Ang University Hospital, 224-1 Heukseok-dong, Dongjak-gu, Seoul, 156-755, Republic of Korea.
authors.forename: Yong Hun
authors.initials: YH
authors.lastname: Jung
authors.affiliation: Department of Surgery, College of Medicine, Chung-Ang University, Chung-Ang University Hospital, 224-1 Heukseok-dong, Dongjak-gu, Seoul, 156-755, Republic of Korea.
authors.forename: Seung Eun
authors.initials: SE
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Chung-Ang University Hospital, 224-1 Heukseok-dong, Dongjak-gu, Seoul, 156-755, Republic of Korea. pain@cau.ac.kr.
authors.forename: Hwa Yong
authors.identifier: 0000-0002-3527-0508
authors.initials: HY
authors.lastname: Shin
mesh_terms: D000328:Adult; D000368:Aged; D000577:Amides; D000779:Anesthetics, Local; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D010791:Phrenic Nerve; D011446:Prospective Studies; D000077212:Ropivacaine; D020069:Shoulder Pain / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D016037:Single-Blind Method; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine
keywords: Cholecystectomy; Laparoscopic; Nerve block; Phrenic nerve; Shoulder pain; Ultrasonography