Skuteczność morfiny podanej dootrzewnowo w zapobieganiu bólom barków po cholecystektomii laparoskopowej

*Sławomir Stempin, Ryszard Gajdosz

Summary
Background.Laparoscopic cholecystectomy and pneumoperitoneum may induce severe shoulder pain during the postoperative period. It may occur after 70% of longer laparoscopic procedures, between the 12^th and 16^th hour after surgery. The purpose of the study was to evaluate the efficacy of intraperitoneal morphine for prevention of this unpleasant complication.
Methods. Ninety adult patients of both sexes, were allocated to three groups to receive, at the end of surgery, 100 mg of bupivacaine in 100 ml of 0.9% NaCl, 100 mg of bupivacaine with 10 mg of morphine sulphate in 100 ml of 0.9% NaCl, or 100 ml of 0.9% NaCl and 10 mg of morphine sulphate intramuscularly. Intraperitoneal injections were made via a drain located near the site of surgery. The drain was closed for 30 minutes after injection. Intensity of shoulder pain was assessed using a VAS scale.
Results. Postoperative shoulder pain was observed in all patients 12 hours after surgery. Patients who did not receive intraperitoneal morphine complained earlier. The mean VAS scores were: at 6 hours - 5.0, 0, and 4.5 (p=0.01 and p=0.005) and at 12 hours – 3.5, 2.7 and 3.4 (p = 0.01 and 0.03). The shoulder pain at 24 hours was less severe and rated 2.1, 1.5 and 2.1 (p=0.002).
Conclusion. Intraperitoneal administration of 100 ml of 0.1% bupivacaine with 10 mg of morphine proved to be an effective method of reducing postoperative shoulder pain following laparoscopic cholecystectomy.

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