The Outcome of Soft Silicone Drains in Reducing Shoulder Tip Pain after Laparoscopic Adrenalectomy
Wisa Anegmudchalin MD*, Kamol Panumatrassamee MD*, Apirak Santi-ngamkun MD*
Affiliation : * Division of Urology, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Background : Intraabdominal carbon dioxide following laparoscopic adrenalectomy results in postoperative shoulder tip
pain. Several interventions to reduce this pain have been used, but were not so effective.
Objective : To evaluate the efficacy of soft silicone drain in reducing shoulder tip pain after laparoscopic adrenalectomy.
Material and Method: A prospective randomized control trial was done on 38 patients undergoing laparoscopic
adrenalectomy and randomized prospectively into two groups in King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
In our previous observational study, we collected data of pain scores from two patient groups after laparoscopic
adrenalectomy. There were five cases with soft silicone drains and five cases without soft silicone drains. We found that
those with drains had significantly decreased mean pain score. In this study, the patients were divided into two groups.
Patients in group A (n = 19) underwent laparoscopic adrenalectomy with soft silicone drains and patients in group B
(n = 19) underwent laparoscopic adrenalectomy without soft silicone drains. Shoulder-tip pain was recorded on a visual
analogue scale (VAS) at 4, 8, 12, 24, and 48 hours after operation. The quantity of analgesics required by the patients were
recorded on the first and second day postoperatively.
Results : Twelve patients in group A (63.2%) and 14 patients in group B (73.68%) complained of shoulder-tip pain. However,
there was no significant difference in the frequency and intensity of shoulder-tip pain between groups A and B. The
postoperative shoulder-tip pain scores were not significantly different between the groups. The quantity of analgesics required
by the patients in the two groups were not significantly different. According to VAS, pain scores were found to be highest at
the fourth and the eighth hours postoperatively. The trends were similar in both groups.
Conclusion : Although our previous observational studies found that drains help reducing shoulder tip pain, our present
randomized control trial found that they could not significantly reduce shoulder tip pain. Further studies to reduce shoulder
tip pain should be conducted.
Keywords : Shoulder tip pain, Soft silicone drain, Analgesic drug, Laparoscopy, Adrenalectomy
