THE IMPACT OF INTRA-PERITONEAL SUB-DIAPHRAGMATIC INSTILLATION OF LOCAL ANESTHESIA ON REDUCING SHOULDER TIP PAIN AFTER LAPAROSCOPIC SURGERY

Objective: to assess the effectiveness of local anesthesia instillation in the subdiaphragmatic area in decreasing the shoulder tip pain after laparoscopic surgery. Methodology: A retrospective comparative study of 240 patients who underwent laparoscopic procedures specifically (Nissen fundoplication, sleeve gastrectomy, and laparoscopic cholecystectomy). The study was conducted at King Hussien Medical Center over a one-year duration from Jan to Dec 2025. Since it’s a comparative study, we classified patients into group A (n=120) who received intraperitoneal local anesthesia and group B (n=120) who underwent surgery without local instillation. Technique: injection of 20 ml of 0.5% bupivacaine (Marcaine) in the Sub-Diaphragmatic region at the end of the laparoscopic procedure (before deflation), taking in considerations the maximum safe dose of bupivacaine <2 mg per Kg. The source of patients' information and medical records was obtained from the electronic medical program HAKEEM. All procedures were performed at King Hussien Medical Center and by the bariatric and laparoscopic surgical team. All data, including demographic (age and gender), types of procedures (Nissen fundoplication, sleeve gastrectomy, and cholecystectomy), intra-operative laparoscopic parameters (flow rate of CO2, intra-abdominal pressure, and the procedure time-length) were observed and recorded. After surgery, all patients were observed to assess the post-operative pain in the 1st 12 hours. The Numeric Rating Scale (NRS, 0-10) was recorded for both groups. The data were analyzed statistically by SPSS IBM software version 28. Results: A total of 240 patients, 50% received the intra-peritoneal, subdiaphragmatic local anesthesia instillation and were grouped A, the another 50% didn’t receive the drug. Regarding demographic features, there were no significant differences in age, sex, or comorbidities, An 130 patients underwent sleeve gastrectomy (Group A =80, Group B =50), 100 (Group A =30, Group B =70), patients underwent laparoscopic cholysystectomy and 10 patients only underwent nissen fundoplication, (Group A =4, Group B =6), a 12 hours after surgery, the Numeric Pain Score (NPS) showed a significant difference in favor of Group A. As shown in Table 1, the mean + SD was 2.2+1 for Group A and 4.8+1.4 for Group B, with a significant P-value (P<0.001). Conclusion: Local anesthesia instillation inside the peritoneal cavity and in the subdiaphragmatic area significantly reduces the postoperative abdominal pain and shoulder tip pain after laparoscopic procedures.