In my clinic I have noticed that female patients complained from shoulder pain immediately after labor with Cesarean section with spinal anesthesia and this condition may be continuous for several months . no complain during pregnancy, by examination of the shoulder no positive signs presented. x-ray was free.
I think that is referred pain from diaphragm.
Patients usually complain that after peritoneal lavage.
The pain is most likely a referral pain from the diaphragm. The phrenic nerve passes through the shoulder area and is usually irritated by the air entrapped during the laparotomy.
Dear Medhat,
Could be for several reasons, one of those is the Kehr's sign (referred pain). It is the occurrence of acute pain in the tip of the shoulder due to the presence of blood or other irritants in the peritoneal cavity.
Someone else could give other opinions to your question, which would be of great interest.
Yours.
most likely it is referred pain due to irrtation of diaphragm by any irritant in the peretonial cavity like fluid, air or others
The above answers are correct. Most common cause (and perhaps the only cause) is the collection of blood, amniotic fluid etc. that drain from uterus during the operation. This collects below the diaphragm and if not carefully prevented from doing so can give rise to pain. However, it should not last for months as you say. Other factors may be involved as clots remaining in situ for a long time. the best thing is to put packs around uterus to prevent the fluid etc. from collection under the diaphragm. However, the very act of placing packs may also cause pain and one has to be careful
I agree with most of the answers, however, I may hesitate on amniotic fluid irritating the diaphragm, as to my mind it will be quickly absorded; however air is not easily absorped and it will cause irritation of the diaphragm causing shoulser pain.
Distention or any pressure on the parietal peritoneum could cause severe irritation of the C5nerve , one of the causes of this pain is the presence of blood or amniotic fluid in the subdiaphragmatic region
maternal hypovolaemia; coagulopathy; infection
at the site of intrathecal catheter or needle insertion; increased
intracranial pressure and patient refusal of regional anaesthesia
The pain is described as sharp, deep and referred, usually begins intraoperatively and continue for 2-3 days after surgery
Although it has no scientific backup, a difference in the rate of pain appearance can be seen in connection with the horizontalization of the operating table. The more anti Trendelenburg the less number of patients with blood cloths behind the uterus and so a decrease of this type of pain postoperative. Also an appropriate "cleaning" of the peritoneal cavity for blood cloths can diminish the rate.
PS: Do you practice the suture of the uterus inside or outside the abdominal cavity?
thank you Cristian furau for your answer but I am an orthopedic surgeon and this complaint a have faced in my clinic.