Shoulder Pain After Laparoscopic Surgery: Causes and Tips for Relief

Laparoscopic surgery is a minimally invasive procedure, often praised for its quick recovery time. However, many patients report an unexpected side effect: shoulder pain. If you're experiencing this discomfort after surgery, don't worry—it's a common and manageable issue.

Why Does Shoulder Pain Occur after Laparoscopic surgery?

The root cause of shoulder pain after laparoscopic surgery lies in using carbon dioxide (CO2) gas. CO2 inflates the abdomen during surgery, creating space for the surgeon to operate. This inflation stretches the diaphragm, which irritates the phrenic nerve, which runs from the neck to the diaphragm and controls breathing. Because this nerve shares pathways with the shoulder, the irritation is felt as pain in that area, a phenomenon known as referred pain.

How Common Is Shoulder Pain After Laparoscopic Surgery?

Shoulder pain is quite common, especially after certain types of laparoscopic procedures. Studies show that:

• 63% of patients after laparoscopic cholecystectomy (gallbladder removal)

• 83% after gynecological laparoscopic surgery

Though the exact mechanism isn’t fully understood, it’s thought that the pressure from CO2 stretches the diaphragm excessively, leading to this phrenic nerve-mediated pain.

How Long Does Shoulder Pain Last?

For most patients, shoulder pain peaks within the first 48 hours after surgery and gradually subsides over a few days. In some cases, the pain may last longer if the CO2 gas remains trapped, if healing is slower than expected, or due to a lack of activity. Being sedentary can slow recovery and keep gas trapped in the abdomen. Gentle walking helps move the gas, increases absorption, and speeds healing. That’s why I encourage my patients to stay active—simply put, the more you walk, the smoother your recovery will be

Intraoperative maneuvers to reduce shoulder pain

During surgery, Dr. Hernandez will utilize the minimum gas pressure necessary to perform the surgery. For instance, some hernia surgeries are accomplished with a pressure as low as 6-8mmHg instead of the typical average pressure used in laparoscopic surgery of 15mmHg. This helps decrease the amount of gas and reduces shoulder pain. Unfortunately, patients with prior abdominoplasty or Tummy tuck, often require higher pressures. Before removing all the Trocars sites (little tubes used to attach laparoscopic instruments), the caps are left open for several minutes to allow gas evacuation.

Additionally, pulmonary maneuvers are performed to promote gas evacuation. 

Tips for Managing Shoulder Pain

While shoulder pain can be uncomfortable, there are several ways to manage it at home:

1. Walk Around: Gentle movement encourages the body to absorb CO2 faster, which reduces pain.

2. Heat Therapy: Applying a heating pad to the shoulder can soothe the discomfort and relax the muscles.

3. Pain Medication: Over-the-counter pain relief, such as ibuprofen or acetaminophen, can help ease the soreness. In combination, muscle relaxants such as Flexeril and Robaxin can also be used. Additionally, Gabapentin can be very effective in the management of nerve pain.

4. Change Your Position: Lying flat or on your side can reduce the pressure on your diaphragm and alleviate the pain.

5. Breathing Exercises: Deep breathing exercises can ease tension in the diaphragm and surrounding muscles, helping reduce shoulder pain after surgery. Try taking a slow, deep breath, hold it for about 6 seconds, then exhale gently. Repeat several times to support comfort and recovery.

6. Gentle Movement: Engaging in light shoulder exercises or gentle stretching can improve circulation and relieve stiffness.

   
   

When Should You Be Concerned?

In most cases, shoulder pain is mild and gradually improves over time. However, if the pain worsens, lasts more than a 3 days, or is accompanied by severe abdominal pain, nausea, or difficulty breathing, it’s essential to contact your provider

The Role of Posture and Movement

Maintaining good posture and staying active (within your doctor's guidelines) can help your body recover faster. Walking, gentle stretching, and proper body alignment can reduce the severity and duration of shoulder pain.

Conclusion

Shoulder pain after laparoscopic surgery is common but temporary. Understanding why it happens and how to manage it can make your recovery smoother. If you experience any unusual symptoms or persistent pain, don’t hesitate to seek medical advice. With some simple home remedies and patience, this discomfort will soon be a thing of the past.

Your safety and recovery are our top priorities—never hesitate to call Dr. Hernandez and the Intercoastal Surgical Group if you have any questions during your recovery in Sarasota and Lakewood Ranch.