Efficacy of Spinal Epidural Anesthesia and Sub Diaphragmatic Lidocaine with Spinal Anesthesia in reduction of shoulder pain: Randomized Clinical trial

Efficacy of Spinal Epidural Anesthesia and Sub Diaphragmatic Lidocaine


  • Din Muhammad Jamali Islamabad Medical and Dental College
  • Tayyab Ali Islamabad Medical and Dental College
  • Bilal Liaqat Chaudhry Islamabad Medical and Dental College
  • Syed Rameez Hassan Islamabad Medical and Dental College
  • Nahin Akhtar Islamabad Medical and Dental College
  • Malik Muhammad Saifullah Awan Islamabad Medical and Dental College




Shoulder pain, humans, hospital, Spinal Epidural, Anesthesia


To determine the efficacy of spinal anesthesia with sub diaphragmatic lidocaine for gynecological laparoscopic surgery at the commencement of the procedure to spinal anesthesia for get pain relief Methods: It was a randomized clinical trial conducted at Ali Medical Hospital in Islamabad. A total of 84 patients were given sub diaphragmatic lidocaine spinal anesthesia, only spinal epidural anesthesia and general anesthesia. During procedure, 2, 4, 6 and 12 hours after surgery, and before discharge, patients' pain perception was measured using Visual Analogue Scale (VAS) Results: Outcomes showed no significant difference in perception of pain at different time intervals in all three groups. (F 4, 77 = 0.38, p = 0.81). At all-time intervals following surgery, patients' pain levels were similar between groups (F 2, 77 = 0.53, p = 0.57). Conclusions: The use of sub diaphragmatic lidocaine at the onset of surgery together with the spinal anesthesia did not result in a prominent statistical difference in patients' postoperative VAS scores when compared to general anesthesia and spinal epidural anesthesia after and prenatal invasive techniques.


Jacobson T Z, Duffy J N M, Barlow D, Koninckx P R, Garry R. Laparoscopic surgery for pelvic pain associated with endometriosis. Scopus Database of Systematic Reviews, 1–12,2019.

Oddit J, Rajagopalan S. A Review of Local Anesthetic Techniques for Analgesia after Laparoscopic Surgery, Journal of Surgical Sciences, 3(3) 2018.

Jun GW, Kim MS, Yang HJ, et al. Laparoscopic appendectomy under spinal anesthesia with dexmedetomidine infusion. Korean J Anesthesiol. 2014;67(4):246-251. doi:10.4097/kjae.2014.67.4.246

Roy KK, Subbaiah M, Naha M, Kumar S, Sharma JB, Jahagirdar N. Intraperitoneal bupivacaine for pain relief after minilaparoscopy in patients with infertility. Archives of gynecology and obstetrics. 2014 Feb;289(2):337-40.doi.org/10.1007/s00404-013-2994-6

Kahokehr A, Sammour T, Soop M, Hill AG. Intraperitoneal use of local anesthetic in laparoscopic cholecystectomy: systematic review and metaanalysis of randomized controlled trials. Journal of Hepato‐Biliary‐Pancreatic Sciences. 2010 Sep;17(5):637-56.doi.org/10.1007/s00534-010-0271-7

Ali Y, Elmasry M N, Negmi H, Ouffi H A, Fahad B S.(vl-2),2019.

Wang XX, Zhou Q, Pan DB, Deng HW, Zhou AG, Guo HJ, Huang FR. Comparison of postoperative events between spinal anesthesia and general anesthesia in laparoscopic cholecystectomy: a systemic review and meta-analysis of randomized controlled trials. BioMed research international. 2016 Jan 1;2016. doi.org/10.1155/2016/9480539

Boddy A P, Mehta S, Rhodes M. The effect of intraperitoneal local anesthesia in laparoscopic cholecystectomy: a systematic review and meta-analysis, Anesthesia and Analgesia, 103(3): 682–688, 2007. doi.org/10.1213/01.ane.0000226268.06279.5a

Hamill JK, Liley A, Hill AG. Intraperitoneal Local Anesthetic for Laparoscopic Appendectomy in Children. Annals of Surgery. 2017 Jul 1;266(1):189-94. doi.org/10.1097/SLA.0000000000001882

Visalyaputra S, Lertakyamanee J, Pethpaisit N, Somprakit P, Parakkamodom S, Suwanapeum P.Intraperitoneal lidocaine decreases intraoperative pain during postpartum tubal ligation.Anesthesia and Analgesia, 89(4): 1077–1080, 1999.doi.org/10.1213/00000539-199905000-00020

Ng A, Swami A, Smith G, Davidson AC, Emembolu J. The analgesic effects of intraperitoneal and incisional bupivacaine with epinephrine after total abdominal hysterectomy. Anesthesia & Analgesia. 2002 Jul 1;95(1): 158-62.doi.org/10.1097/00000539-200207000-00028

Ceyhan T, Teksoz E, Gungor S, Goktolga U, Pabuccu R. Effect of bupivacaine after operative laparoscopic gynecologic procedures. Journal of minimally invasive gynecology. 2005 Aug 1;12(4):326-9. doi.org/10.1016/j.jmig.2005.05.003

Kaufman Y, Hirsch I,Ostrovsky L, et al. Pain Relief by Continuous Intraperitoneal Nebulization of Ropivacaine during Gynecologic Laparoscopic Surgery-A Randomized Study and Review of the Literature, Journal of Minimally Invasive Gynecology, 15(5): 554–558, 2008. doi.org/10.1016/j.jmig.2008.05.012

Abdelazim I, Al-Kadi M, El Shourbagy MM, Mohamed AA, Abu Fasel ML. Intraperitoneal lidocaine tenoxicam for pain relief after gynecological laparoscopy. Asian Pac. J. Reprod. 2013 Jun 1; 2:146-50. doi.org/10.1016/S2305-0500(13)60136-0

Cruz JJ, Diebolder H, Dogan A, Mothes A, Rengsberger M, Hartmann M, et al. Combination of pre-emptive port-site and intraoperative intraperitoneal ropivacaine for reduction of postoperative pain: a prospective cohort study. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2014 Aug 1; 179: 11-6.doi.org/10.1016/j.ejogrb.2014.05.001

Marks JL, Ata B, Tulandi T. Systematic review and metaanalysis of intraperitoneal instillation of local anesthetics for reduction of pain after gynecologic laparoscopy. Journal of minimally invasive gynecology. 2012 Sep 1;19(5): 545-53.doi.org/10.1016/j.jmig.2012.04.002

Nutthachote P,Sirayapiwat P, Wisawasukmongchol W, Charuluxananan S. A Randomized, Double-Blind, PlaceboControlled Trial of Oral Pregabalin for Relief of Shoulder Pain after Laparoscopic Gynecologic Surgery, Journal of Minimally Invasive Gynecology, 21(4): 669–673, 2014. doi.org/10.1016/j.jmig.2014.01.018

Jarrell J, Ross S,Robert M et al. Prediction of postoperative pain after gynecologic laparoscopy for nonacute pelvic pain, American Journal of Obstetrics and Gynecology, 211(4) :360–360.e8, 2014. doi.org/10.1016/j.ajog.2014.04.010

Catenacci SS, Lovisari F,Peng S. et al. Postoperative analgesia after laparoscopic ovarian cyst resection: double-blind multicenter randomized control trial comparing intraperitoneal nebulization and peritoneal instillation of ropivacaine, Journal of Minimally Invasive Gynecology, 22(5): 759–766, 2015.

Karaman S, Kocabas S, Ergun S, Firat V, Uyar M, endag FS.Intraperitoneal ropivacaine or ropivacaine plus meperidine for laparoscopic gynecological procedures, Agri, vol. 24, no. 2, pp. 56–62, 2012. doi.org/10.5505/agri.2012.21033

Goldstein A, Grimault P, Henique A, Keller M, Fortin A, Darai E. Preventing postoperative pain by local anesthetic instillation after laparoscopic gynecologic surgery: a placebocontrolled comparison of bupivacaine and ropivacaine, Anesthesia and Analgesia, 91(2): 403–407, 2000.doi.org/10.1213/00000539-200008000-00032

Callesen T,Hjort D, Mogensen T, et al. Combined field block and i.p. instillation of ropivacaine for pain management after laparoscopicsterilization, British Journal of Anaesthesia,82(4): 586–590, 1999. doi.org/10.1093/bja/82.4.586

Sherbiny WE1, Saber W, Askalany AN, Daly AE1, et al. Effect of intra-abdominal instillation of lidocaine during minor laparoscopic procedures, International Journal of Gynecology and Obstetrics, 106(3) 3: 213–215, 2009. doi.org/10.1016/j.ijgo.2009.04.016

Manjunath AP,Chhabra N, Girija S,Nair S.Pain relief in laparoscopic tubal ligation using intraperitoneal lignocaine: A double masked randomized controlled trial, European Journal of Obstetrics Gynecology and Reproductive Biology, 165(1): 110–114, 2012. doi.org/10.1016/j.ejogrb.2012.06.035

Saleh A, Fox G, Felemban A,Guerra C, Tulandi T. Effects of local bupivacaine instillation on pain after laparoscopy. Journal of the American Association of Gynecologic Laparoscopists, 8(2): 203–206, 2001. doi.org/10.1016/S1074-3804(05)60578-6

Fong SY, Pavy TJ, Yeo ST,Paech MJ, Gurrin LC. Assessment of wound infiltration with bupivacaine in women undergoing day-case gynecological laparoscopy. Regional Anesthesia and Pain Medicine, 26(2): 131 – 136, 2001. doi.org/10.1097/00115550-200103000-00007

Collins GG, Gadzinski JA,Fitzgerald GD, et al. Surgical Pain Control With Ropivacaine by Atomized Delivery ( Spray ): A Randomized Controlled Trial. Journal of Minimally Invasive Gynecology, 23(1): 40–45, 2016. doi.org/10.1016/j.jmig.2015.07.018

Andrews V,Wright JT,Zakaria F,Banerjee S, Ballard K. Continuous infusion of local anaesthetic following laparoscopic hysterectomy - A randomised controlled trial.BJOG: An International Journal of Obstetrics and Gynaecology, 121(6): 755–761, 2014.doi.org/10.1111/1471-0528.12610

Arden D, Seifert E, Donnellan N, Guido R, Lee T, Mansuria S. Intraperitoneal Instillation of Bupivacaine for Reduction of Postoperative Pain After Laparoscopic Hysterectomy: A Double-Blind Randomized Controlled Trial. Journal of Minimally Invasive Gynecology, 20 (5): 620–626, 2013. doi.org/10.1016/j.jmig.2013.03.012




How to Cite

Muhammad Jamali, D. ., Ali, T. ., Liaqat Chaudhry, B. ., Hassan, S. R. ., Akhtar, N. ., & Saifullah Awan, M. M. (2022). Efficacy of Spinal Epidural Anesthesia and Sub Diaphragmatic Lidocaine with Spinal Anesthesia in reduction of shoulder pain: Randomized Clinical trial: Efficacy of Spinal Epidural Anesthesia and Sub Diaphragmatic Lidocaine. Pakistan BioMedical Journal, 5(5), 282–287. https://doi.org/10.54393/pbmj.v5i5.468



Original Article