INCIDINCE AND RISK FACTOR OF TIP SHOULDER PAIN IN LAPAROSCOPIC SURGERIES UNDER GENERAL ANESTHESIA IN TERTIARY CARE HOSPITAL IN PESHAWAR PAKISTAN

Abstract

Post laparoscopic shoulder tip pain (PLSP) is a well-documented but frequently managed complication following laparoscopic cholecystectomy. Referred shoulder pain caused by phrenic nerve irritation from residual carbon dioxide (CO2) pneumoperitoneum significantly affects post-operative patient comfort and delayed discharge. This study aimed to determine the current incidence, clinical severity distribution, and specific intraoperative risk factors (such as surgical duration and gas pressure) associated with post-laparoscopic shoulder tip pain among patients undergoing elective laparoscopic cholecystectomy under general anesthesia in any tertiary care hospital. A multi-center, cross-sectional observational study was conducted involving a total cohort of 215 adult patients across two tertiary care hospitals in Peshawar. Standardized data collection charts were utilized to record demographics, intraoperative variables, and post-operative pain scores within the first 6 hours. Pain intensity was classified using a 0–10 Visual Analogue Scale (VAS) into mild (1–3), moderate (4–6), and severe (7–10) categories. Data were analyzed using descriptive statistics and Pearson Chi-Square tests (x²) in SPSS version 26, with a significance threshold set at p < 0.05. The final statistical analysis revealed an overall PLSP incidence rate of 41% (n = 88) within the total study population. In terms of pain severity breakdown, 35% (n = 75) of the patients experienced mild, tolerable pain; 4% (n = 9) suffered from moderate, distracting pain; and 2% (n = 4) faced severe, distressing pain that limited normal mobility. SPSS Chi-Square testing demonstrated that a surgical duration exceeding 60 minutes (x² = 14.820, p = 0.000) and the use of high intra-abdominal pneumoperitoneum pressure (x² = 19.450, p = 0.000) were highly significant independent risk factors for the onset and severity of PLSP. Conversely, the institutional setting or hospital site itself showed no statistically significant association with pain occurrence (x² = 0.114, p = 0.945). While the pain is predominantly mild, the sub-fraction of patients experiencing moderate-to-severe distress underscores the need for standardizing preventive strategies.