Shoulder Tip Pain After Laparoscopic Surgery Analgesia by Collateral Meridian Acupressure (Shiatsu) Therapy: A Report of 2 Cases
Received 18 September 2007; received in revised form 31 March 2008; accepted 31 March 2008.
Abstract
Objectives
This article describes 2 cases of collateral meridian acupressure (shiatsu) therapy (CMAT) for treatment of shoulder tip pain after laparoscopic cholecystectomy (LC). Both cases showed marked pain relief with reduction of skin temperature (1°C) of the affected shoulder after CMAT.
Clinical Features
A 32- and a 53-year-old female presented with right shoulder tip pain after LC surgery. The repeated dose of intravenous ketorolac 30 mg and meperidine 50 mg did not improve the pain. Because of persistent pain and episodes of nausea and vomiting after intravenous nonsteroidal anti-inflammatory drugs and opioid medications, patients refused to take more analgesics, and we were consulted for pain management.
Intervention and Outcome
After informed written consent obtained, CMAT was performed using acupoints located on the contralateral (left) kidney meridian to treat affected (right) shoulder pain. Postoperatively, patients' pain intensity was measured using a numeric pain scale. The infrared thermography of shoulder tip was obtained before and after the CMAT. Both patients reported immediate pain relief after the CMAT, with pain scores decreased from 5 to 1 of 10 and 5 to 0 of 10, respectively. Moreover, the local skin temperature of affected shoulders were significantly decreased in both patients after the CMAT. Similarly, the temperature difference between patients' affected and nonpainful shoulders were also significant after the CMAT.
Conclusion
The results of these 2 cases suggest that the CMAT may be effective in reducing patients' post-LC shoulder tip pain without medication. An associated reduction of skin temperature of the painful shoulder with CMAT warrants further investigation.
aAssistant Professor and Attending Physician of Anesthesiology, Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
bChairman of Painless Ginza Hospital, Tokyo, Japan
cAssociate Professor of Anesthesiology, Department of Anesthesiology, Division of Pain Management, Duke University Medical Center, Durham, North Carolina
dInstructor and Attending Physician of Anesthesiology, Department of Anesthesiology, Tri-Service General Hospital, Taipei, Taiwan
eAssociate Professor and Chairman of Anesthesiology, Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
fProfessor of Anesthesiology and Chairman, School of Medicine, Deputy Superintendent, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
Submit requests for reprints to: Chih-Shung Wong, MD, PhD, Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, #325, Section 2, Chenggung Road, Neihu 114, Taipei, Taiwan, Republic of China. Shan-Chi Ko, MD, Painless Ginza Hospital, Tokyo, Japan
ABSTRACT