Effectiveness of intraperitoneal instillation of normal saline in reducing shoulder tip pain following laparoscopic cholecystectomy - A randomised controlled trial from North India.

Abstract

Introduction: Shoulder tip pain (STP) is a post-operative complication seen in up to 60% of patients after LC. It occurs because of diaphragmatic irritation from residual carbon dioxide from pneumoperitoneum. This study evaluated the effect of intraperitoneal normal saline irrigation in relieving STP.

Patients and methods: This randomised trial was conducted at Department of General Surgery, Government Medical College and Hospital, Chandigarh of North India between August 2024 and February 2025. A total of 158 patients underwent randomisation, and after exclusion, 63 participants were enrolled in Group A (intervention) and Group B (control). The Visual Analogue Scale (VAS) scores were measured at 6th, 12th, 24th and 48th h.

Results: The mean age of the patients in Group A was 42.57 ± 13.93 years and in Group B was 42.15 ± 15.15 years (P = 0.75). A female predominance was noted in both groups. The mean duration of surgery was slightly higher in Group A (36.19 ± 11.82 min) compared to Group B (33.28 ± 10.56 min) (P = 0.860). The primary outcome was STP, evaluated using the VAS. At 6 h, mean VAS score was 1.31 in Group A versus 2.96 in Group B (P = 0.000); at 12 h, 1.09 versus 2.84 (P = 0.000); at 24 h, 0.53 versus 1.73 (P = 0.0004) and at 48 h, 0.12 versus 0.76 (P = 0.0006), highlighting the effectiveness of the intervention in reducing post-operative STP.

Conclusion: This study demonstrates that intraperitoneal normal saline instillation is an effective and safe intervention for reducing STP after laparoscopic cholecystectomy.