Omalgia in Laparoscopic Kidney SurgerySandro Gaspar*, José Santos Dias and Tomé Lopes
Department of Urology, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Portugal
- *Corresponding Author:
- Sandro Gaspar
Department of Urology
Hospital Santa Maria, Centro Hospitalar
Lisboa Norte, Portugal
E-mail: [email protected]
Received date: February 07, 2015; Accepted date: March 07, 2015; Published date: March 11, 2015
Citation: Gaspar S, Dias JS, Lopes T (2015) Omalgia in Laparoscopic Kidney Surgery. Med Surg Urol 4:148. doi: 10.4172/2168-9857.1000148
Copyright: © 2015 Gaspar S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Minimal invasive surgery has well-known advantages. The majority of procedures performed on the kidney are now-a-days laparoscopic, with several advantages over laparotomy: decreased perioperative morbidity and mortality, smaller incisions, faster recovery, shorter hospital stays and earlier return to active life. Postoperative pain is the most common complaint and an important issue following laparoscopic surgery. There are different theories proposed to explain omalgia: distension of the peritoneal blood vessels and nerves during pneumoperitoneum, the associated inflammatory reaction (release of proinflammatory cytokines), rate of CO2 infusion; distension of the triangular and round ligament; time of exposure to the gas; gas retention inducing irritation of the phrenic nerve; nerve injury during patient positioning (shoulder abduction) and diaphragm injury. Debate still exists on how to minimize it. We review the different etiologic mechanisms and proven and potential preventive measures and treatments on how to avoid postoperatory pain: proper patient positioning, pulmonary recruitment maneuvers, intraperitoneal normal saline infusion, using gabapentin, pregabalin, irrigation with bupivacaine, using NSAIDs, opioids and hydrocortisone.