Shoulder Pain After Robotic Surgery: Causes and Tips for Relief

Robotic 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 Robotic surgery?

It’s common to feel shoulder pain after robotic surgery. This happens because the surgeon uses carbon dioxide gas to gently inflate the abdomen and create space to work. The gas can irritate a nerve near the diaphragm that also connects to the shoulder. This nerve is the phrenic nerve. The body sometimes mixes up these signals, you may feel the irritation as shoulder pain. This is called referred pain, and it usually improves as your body absorbs the gas.

How Common Is Shoulder Pain After Robotic Surgery?

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

• 63% minimally invasive gallbladder removal

• 83% after gynecological 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 utilizes the minimum gas pressure necessary to perform surgery. For instance, some hernia surgeries are accomplished with a pressure as low as 6-8mmHg instead of the typical average pressure used in robotic surgery of 15mmHg. This helps decrease the amount of gas and reduces stretching of the diaphragm thereby reducing referred pain. Unfortunately, patients with prior Tummy tuck, often require higher pressures to achieve adequate working room inside the abdomen and may experience higher postoperative pain. Before removing all the Trocars sites (little tubes used to attach robotic 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. Usually, a pain regimen using different pathways is the most effective.

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 and Massage: 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 robotic surgery is common and usually short-lived. Knowing why it happens and how to ease it can help you recover more comfortably. If pain lingers or new symptoms appear, be sure to contact your doctor. With simple home remedies and a little patience, the discomfort typically fades quickly.

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.