Effect of Utilizing a Drain on Shoulder Pain in Laparoscopic Cholecystectomy. A Randomized Clinical Trial

Post-laparoscopic shoulder pain is still one of the most important complications of laparoscopic cholecystectomy. Placing a drain after laparoscopic cholecystectomy is controversial among surgeons. It is believed that shoulder pain after laparoscopic cholecystectomy is associated with insufflation of high-pressure CO2 and accumulation of residual gas in subhepatic area. Here, a randomized clinical trial was designed to evaluate the role of a routine drain on shoulder pain after laparoscopic cholecystectomy. One hundred and twenty candidates for laparoscopic cholecystectomy were enrolled in this randomized clinical trial. Among all, 50 patients were randomized to have drain in subhepatic space (group A) and 50 patients did not have it. An investigation was performed by visual scale according to having shoulder pain, abdominal pain, nausea, and vomiting during 6, 12, 24, and 48 h after operation in both groups. Abdominal pressure and anesthetic recovery medications were the same for both groups. Overall, the tip shoulder pain in (group A) was lower than patients in (group B). The mean range of shoulder pain scores after 6, 12, 24, and 48 h in group A is significantly lower than that in group B (p < 0.001). The scores for post-operation abdominal pain in groups A and B had no significant difference (p = 0.13). Moreover, no significant difference was found between shoulder pain in two groups but increasing one unit of BMI decreased vomiting to 34%. By the way, the correlation between BMI and vomiting was statistically significant. It seems that draining after laparoscopic cholecystectomy leads to less postoperative shoulder pain.