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Shoulder Tip Pain Laparoscopy Management — FRCA Final MCQ

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EasyDay SurgeryShoulder Tip Pain Laparoscopy ManagementFRCA Final

A 40-year-old woman (ASA I) undergoes diagnostic laparoscopy under GA. Post-operatively she complains of severe right shoulder tip pain (8/10) that is worse than her surgical pain. What simple non-pharmacological intervention may help?

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Correct answer: A — Cervical spine immobilisation

Post-laparoscopic shoulder tip pain from diaphragmatic irritation by residual CO2 is very common (35-80%). Mobilisation and upright positioning encourage CO2 absorption and redistribution from the subdiaphragmatic space. Other helpful measures: NSAID (ketorolac 30 mg IV or diclofenac 75 mg IM), paracetamol, and ensuring thorough desufflation of the pneumoperitoneum at the end of surgery. Some surgeons instil local anaesthetic into the subdiaphragmatic space. The pain typically resolves within 24-48 hours. Simple reassurance that it is not a cardiac or orthopaedic problem is also important.

Reference: RCOA – 2023 – Day surgery/laparoscopic anaesthesia; BADS – 2019 – Discharge management