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Analgesic effect of trigger point injection and EMLA for shoulder pain in patients undergoing total laparoscopic hysterectomy: A randomized controlled study

 Ji Eun Kim  ;  Ji Young Kim  ;  Hye Sun Lee  ;  Suhyun Seok  ;  Hae Keum Kil 
 Medicine, Vol.98(2) : e14087, 2019 
Journal Title
Issue Date
Adult ; Aged ; Anesthetics, Combined/therapeutic use* ; Anesthetics, Local/therapeutic use* ; Female ; Humans ; Hysterectomy*/methods ; Injections ; Laparoscopy ; Lidocaine, Prilocaine Drug Combination/therapeutic use* ; Middle Aged ; Occlusive Dressings ; Pain, Postoperative/drug therapy* ; Ropivacaine/therapeutic use* ; Shoulder Pain/drug therapy* ; Shoulder Pain/etiology ; Single-Blind Method ; Treatment Outcome ; Trigger Points
BACKGROUD: The purpose of this study was to evaluate the effects of trigger point injection (TPI) and eutectic mixture local anesthetics (EMLA) cream on the postoperative shoulder pain in patients undergoing total laparoscopic hysterectomy. METHODS: In this randomized, single-blinded, and controlled study, total 75 patients were randomly allocated to TPI group (n = 25), EMLA group (n = 25), and control group (n = 25). TPI group received TPIs with 2 mL of 0.2% ropivacaine, and EMLA group received an occlusive dressing with EMLA cream 2 g on both shoulders. Overall, abdominal, and shoulder pains were evaluated at rest and in motion on postoperative day 3. RESULTS: The incidence of shoulder pain was significantly reduced in EMLA group (56%) compared to control (88%) or TPI (88%) groups (P = .025 in both); the severity of shoulder pain was mitigated in EMLA and TPI groups compared to control group (P < .001, each). Consequently, the overall pain decreased in EMLA group and TPI group (P = .023). The patients with exercise habit (n = 31) showed lower incidence of pain than patients without exercise habit (n = 26) (P = .002, P = .005, and P = .037 in overall, abdominal, and shoulder pain, respectively). TPI or EMLA treatments decreased shoulder pain irrespective of exercise habit (P = .001 and P < .001, respectively), but decreased overall pain only in patients without exercise habit (P = .019). Lastly, EMLA lowered overall pain score at the time of first analgesic request in ward compared to control group (P = .02). CONCLUSIONS: TPI and EMLA with occlusive dressing effectively reduced the shoulder pain after total laparoscopic hysterectomy.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kil, Hae Keum(길혜금)
Kim, Ji Young(김지영) ORCID logo https://orcid.org/0000-0001-5822-0338
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