A Comparative Study between Soda- Bicarbonate and Lignocaine Via Intra- Peritoneal Irrigation in Reducing Post-Operative Shoulder Tip Pain in Patients Undergoing Laparoscopic Cholecystectomy

Abstract

Background: Post-operative shoulder tip pain is a common complaint after laparoscopic cholecystectomy and is mainly attributed to diaphragmatic irritation caused by residual carbon dioxide pneumoperitoneum. Various intraperitoneal agents have been used to minimise this discomfort. This study aimed to compare the effectiveness of sodium bicarbonate and lignocaine administered via intraperitoneal irrigation in reducing postoperative shoulder tip pain.

Methods: This prospective, randomised comparative study was conducted in the Department of General Surgery at Integral Institute of Medical Sciences and Research (IIMS&R), Lucknow, over 18 months. A total of 100 patients undergoing elective laparoscopic cholecystectomy were randomly divided into two groups (n=50 each). Group A received 50 ml of 7.5% sodium bicarbonate diluted in 1000 ml normal saline, while Group B received 10 ml of 2% lignocaine diluted to 50 ml with normal saline for intraperitoneal irrigation. Postoperative pain was assessed using the Visual Analog Scale (VAS) at 6, 18, and 24 hours and at 1 week postoperatively. Incidence of shoulder tip pain, port-site pain, rescue analgesic requirement, and adverse effects were also recorded. Statistical analysis was performed using SPSS version 26.0, with p<0.05 considered significant.

Results: Baseline demographic and operative parameters were comparable between both groups. The incidence of shoulder tip pain was lower in the sodium bicarbonate group (60%) compared to the lignocaine group (72%). Mean shoulder pain VAS scores were significantly lower in Group A at 6 hours (3.2±1.1 vs 3.8±1.3; p=0.014), 18 hours (2.5±0.9 vs 3.1±1.0; p=0.002), and 24 hours (1.8±0.7 vs 2.4±0.9; p<0.001). Port-site pain was also lower in the sodium bicarbonate group at 18 and 24 hours. Rescue analgesic requirement was significantly reduced in Group A during the first 24 hours. Adverse effects were minimal and comparable in both groups.

Conclusion: Intraperitoneal irrigation effectively reduces postoperative pain after laparoscopic cholecystectomy. Sodium bicarbonate was more effective than lignocaine in reducing postoperative shoulder tip pain and early analgesic requirement, while both agents were safe and well tolerated. Incorporating sodium bicarbonate irrigation may improve postoperative recovery and patient comfort following laparoscopic cholecystectomy.