What is the cause of shoulder pain following laparoscopic procedures?
The commonest distension medium used in laparoscopy is carbon dioxide gas. Carbon dioxide is 20 times more soluble in body fluids than air or oxygen.
When pneumoperitoneum is created with carbon dioxide during a laparoscopic procedure, Carbonic acid is formed inside the abdomen.
Carbonic acid becomes adherent to diaphragm . The diaphragmatic irritation with Carbonic acid is responsible for the shoulder pain following Laparoscopic procedures.
The ideal solution to prevent this adhesion of carbonic acid to the diaphragm is Ringer lactate solution.
How much peritoneal wash should be given with Ringer lactate?
Peritoneal wash must be given with warm Ringer lactate till the crystal clear solution stays inside the abdomen.
Some amount of Ringer lactate solution has to be left inside the abdominal cavity for the lubrication of the intestines, thus preventing future adhesions.
( Normally also there is some amount of biologic fluid inside the abdomen for lubrication. Hence it is not recommended to suck out all the irrigation fluid back from the peritoneal cavity after an abdominal surgery)
