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It is The saphenous nerve is the sensory component of the femoral nerve after it enters the adductor canal, and it provides sensory innervation to the medial aspect of the ankle. A ruptured spleen can cause pain in the left shoulder because bleeding from the spleen may irritate the phrenic nerve, a nerve that originates in the neck and extends through the diaphragm. After surgery, you may feel sleepy, so you should try and take frequent naps. EDITOR: Shoulder pain after laparoscopic surgery has been thought to be due to the irritation of the phrenic nerve, which may be mainly caused by insufflated carbon dioxide .However, shoulder pain can be caused by stretching of the shoulder, which is constrained by many muscles and ligaments .We investigated postoperative shoulder pain in 72 patients who underwent gynaecological laparoscopy by . The nerve run downs the neck to the diaphragm, but also branches out to the left shoulder - so the feeling of pain is mistakingly referred out there when the diaphragm . . It can result from irritated diaphragmatic nerves. A pulmonary recruitment maneuver consisting of five manual pulmonary inflations was performed with a maximum pressure of 60 cmH2O. Other possible causes of phrenic nerve injury include birth trauma, surgery, and infection. One way to relieve phrenic nerve pain after surgery is to drink lots of water and use heat packs. Thoracic diaphragm and visceral therapy should be considered in shoulder pathology. A pulmonary recruitment maneuver consisting five manual pulmonary inflations was performed with a maximum pressure of 60 cmH2O. This method can help prevent shoulder pain and can also ease diaphragm pain. The pain tends to be at the tip of the shoulder. This video demonstrates surgical repair of the phrenic nerve in a patient diagnosed with right diaphragm paralysis resulting from a prior neck surgery. Phrenic nerve irritation, following a laparoscopic surgery, can impact both motor and sensory functions. Epub 2010 Dec 8. Alopecia is an immuno-disorder whereby your immune system mistakenly attacks your hair follicles, causing them to become inflamed, resulting in ultimate hair loss. There are a number of theories regarding the mechanism of pain generation, focusing on both the mechanical trauma of peritoneal distension and the effect of the insufflated carbon dioxide. Decreasing Upper and Shoulder Pain After Laparoscopic Surgery - Full Text View Brief Summary: Laparoscopic surgery is becoming a major procedure, owing to smaller incisions, shorter hospitalizations, and . It originates in the neck and travels to the diaphragm, where it gives off pain. Maneuvers to Decrease Laparoscopy-Induced Shoulder and Upper Abdominal Pain: A Randomized Controlled Study. Goldberg J, Falcone T. Gasless Gynecologic Laparoscopy. Retrieved from http://hcp.obgyn.net/laparoscopy/content/article/1760982/1894615, 6105 PEACHTREE DUNWOODY ROADBUILDING B, SUITE 230ATLANTA, GA 30328PHONE: 770-913-0001FAX: 770-913-0005. Thoracic surgeons treat patients who require surgical solution to diseases and disorders of the chest, including disorders of the diaphragm. To receive credit as the author, enter your information below. This can be too painful for some people, however. A small amount of it dissolves in the moisture on the surface of the Demco, L. Painless Laparoscopy? This can cause pain in the chest, upper chest, and shoulder region. If you are unable to tolerate the pain, you can ask a nurse to provide you with a narcotic analgesia that will make you sleep. In particular, carbon dioxide-induced Phrenic nerve irritation causes referred pain to cervical nerve 4 (C4). Choi YM, Byeon GJ, Park SJ, Ok YM, Shin SW, Yang K. J Clin Anesth. Pain in the shoulder after laparoscopy is due to irritation of the Bring headphones with you. Pain in the right shoulder and arm is often due to muscle or tendon damage. The purpose of this study was to compare the . Shoulder pain after laparoscopic surgery has been thought to be due to the irritation of the phrenic nerve, which may be mainly caused by insufflated carbon dioxide. Intraoperative chest fluoroscopy is performed to . Pleurisy Pleurisy refers to inflammation of the pleura, which is the layer of tissue on the inner side of the chest cavity surrounding the lungs. Keywords provided by Taipei Veterans General Hospital, Taiwan: Procedure: Pulmonary recruitment maneuver, Procedure: Intraperitoneal normal saline infusion. The hypothesis of post-operative shoulder-tip pain is that carbon dioxide induced phrenic nerve irritation causes referred pain to C4. you are worried that the pain in your shoulder after a surgery is due to If you can get hold of peppermint oil liquid, many persons have reported Passing gas after surgery is completely normal, and its a good sign. It can result from a partial or complete transection of the nerve. During the night following the operation or on the first post-operative day 30.5% of the 200 patients had sub-phrenic pain and 54.5% had shoulder pain. Acquired defects, which occur as the result of an injury, accident or surgery. Whether it is diving the ocean, and seeing creation beyond my imagination, or being in the pit of the quarry with not even a shadow in sight, knowing that there is light to cover the expanses of darkness. 2020 May 29;13(2):45-49. eCollection 2020 May. Sodium Bicarbonate Sub-Diaphragmatic Irrigation Relieves Shoulder Pain After Total Laparoscopic Hysterectomy: A Randomized Controlled Trial. After the procedure, the patient should be moved from a seated to a standing position. Pulmonary recruitment manoeuvre: Recruitment manoeuvres (RM) can be defined as a voluntary strategy to increase the transpulmonary pressure (PL) transiently with the goal to reopen those alveolar units that are not aerated or poorly aerated but reopenable. Yi-Jen, Chen, M.D., Ph D., Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, The severity and frequency of upper abdominal and shoulder pain after laparoscopic surgery [TimeFrame:The first 48 hours after the surgery], nausea or abdominal fullness after laparoscopic surgery [TimeFrame:The first 38 hours after the surgery], Patients receive benign gynecological laparoscopic surgery. 11 Because data on preexisting phrenic nerve paresis, chronic pain issues, or measures to evaluate the same in the patients mentioned in the . You have reached the maximum number of saved studies (100). Phrenic nerve pain is a common complication following laparoscopic surgery. 2015 Dec 21;21(47):13386-95. doi: 10.3748/wjg.v21.i47.13386. Pillows can be used to prop up the shoulder, which will keep the pain away from the injured area. If you experience these, try gently massaging your tummy to release trapped gas. Mechanism of pain: The hypothesis of post-operative shoulder-tip pain is that carbon dioxide induced phrenic nerve irritation causes . Shoulder pain after a keyhole or minimally invasive surgery (laparoscopy) . The CO2 is inhaled at 70degF, and the effect it has on the diaphragm results in pain and discomfort. Rather, the sufferer would deteriorate if nothing is done. Therefore, the investigators should try to reduce carbon dioxide retention in the pelvic cavity. Multiple research studies have hypothesized that PLSP is due to phrenic nerve irritation at the diaphragmatic level, creating referred pain Danelli G, Berti M, Casati A, Bobbio A, Ghisi D, Mele R, Rossini E, Fanelli G. Eur J Anaesthesiol. (You can preview and edit on the next page), Help Keep This Site GoingDonate To Show Your Support, Return To Home Page from Shoulder Pain After Laparoscopy Page, YOUR GUIDE TO CAUSES AND TREATMENT OF ABDOMINAL PAIN, Upload 1-4 Pictures or Graphics (optional), Hi, About 18 months ago I had to call an ambulance as I had severe pain in my abdomen on the left side. Background Post-laparoscopic shoulder pain (PLSP) frequently follows a laparoscopic cholecystectomy. You can also use a heat pack on your lower abdomen to help with the pain. Structure and Function The phrenic nerve originates from the anterior rami of the C3 through C5 nerve roots and consists of motor, sensory, and sympathetic nerve fibers. World J Surg. It is due to the gas It can also settle up under the diaphragm and cause pain in the upper and lower chest. This inflammation can lead to sharp, achy pain. However, these side effects are likely to disappear quickly, and you should be able to resume normal activities in a few days. 1,2 Pain in laparoscopic abdominal surgeries is due to 3 components: somatic (port site incision), visceral (peritoneal), and phrenic nerve irritation (shoulder tip pain). . The Phrenic nerve arises on each side of the neck, from the 3rd, 4th and 5th cervical spine roots. The intense sharp pain in the left shoulder is caused by the damage to the phrenic nerve that can sometimes (certainly not always) happen during nissan fundoplication surgery. diaphragm causing irritation of the diaphragm. Rarely, shoulder pain after laparoscopy could be due to internal Laparoscopic Surgeon 10 yrs exp Ghaziabad. You can take up to To suffer shoulder tip pain due to internal bleeding, you would have The pain can be relieved by applying heat to the area. Background Laparoscopic surgery has become a standard of care for many gynecological surgeries due to its lower morbidity, pain and cost compared to open techniques. lasts for more than 5 days. Summary. For many, they do not The pain is then referred upward through the nerves until it lands in the shoulder. It may also help to rock your knees from side to side. pregnancy who have bled significantly. var months=new Array(13);months[1]="January";months[2]="February";months[3]="March";months[4]="April";months[5]="May";months[6]="June";months[7]="July";months[8]="August";months[9]="September";months[10]="October";months[11]="November";months[12]="December";var time=new Date();var lmonth=months[time.getMonth()+1];var date=time.getDate();var year=time.getYear();if(year<2000)year=year+1900;document.write(""+lmonth+" ");document.write(date+", "+year+""); Shoulder pain after laparoscopy is very common. The pain caused by trapped CO2 was once thought to be caused by the reaction of CO2 with water. To relieve pain after surgery, apply heat to the shoulder area and take prescribed pain medication. After laparoscopy, the gas it let out, but some will certainly For more information or to schedule a consultation, please call (855) 233-3681. There is marked interindividual variability of post-operative shoulder-tip pain following laparoscopic surgery. This : This shoulder pain is a common complaint following laparoscopic surgery.This type of pain is called referred pain. It provides support and reminds patients not to move their arm. This gas can irritate the nerve and cause pain in the chest and shoulder areas. Edinoff AN, Girma B, Trettin KA, Horton CC, Kaye AJ, Cornett EM, Imani F, Bastanhagh E, Kaye AM, Kaye AD. Background: You can also fold a pillow to reduce the pain when you breathe. Posted March 16, 2011. The hypothesis of post-operative shoulder-tip pain is that carbon dioxide induced phrenic nerve irritation causes referred pain to C4. The anesthesiologist held the fifth positive pressure inflation for approximately 5 seconds. Kehrs sign is a classic example of referred pain: irritation of the diaphragm is signaled by the phrenic nerve as pain in the area above the collarbone. Unable to load your collection due to an error, Unable to load your delegates due to an error. So your musculature could pinch down and cause a problem with that phrenic nerve. In some cases, it has been reported to last more than 72 hours after surgery. rate at wish the trapped carbon dioxide inside you escapes out. Your doctor may use dissolvable stitches to close the incisions. A phrenic nerve is made up of axon fibers that originate in the neck and travel to the diaphragm. The phrenic nerve is located near the C4 and C5 vertebral levels of the neck. Management: . It begins at the C3 vertebra, which aligns with the jaw and rotates the neck. You can use ibuprofen or Tylenol to help you deal with the discomfort. With each dive I feel like I meet my Maker. Weight Lost: 79 lbs. Do you have some pictures or graphics to add? To help relieve diaphragm pain after laparascopy, you can practice breathing exercises. Fortunately, newer techniques are making it easier to manage this condition. that send pain signals to both the shoulder and the diaphragm, the brain is Phrenic nerve reconstruction may involve neurolysis, interposition nerve grafting, and/or neurotization, depending on the extent of the injury. and you really want something to relief it, there are a few things you can do These nerves run to the shoulder, and if they are stimulated, it can cause shoulder pain. Because it is the same nerve Phrenic nerve damage symptoms. Tsai HW, Wang PH, Yen MS, Chao KC, Hsu TF, Chen YJ. However, this gas can also irritate the nerves and affect the physiology of the surrounding peritoneal tissue.It was once believed the resultant shoulder pain was simply due to reaction of the gas combining with water, or that it was merely trapped CO2. However, the actual cause of the irritation is the result of cellular death (not as formidable as it sounds - this is simply a direct response to tissue injury, considered part of the wound-healing process itself) caused by the combination of a temperature change from the gas at 70F and the drying effect of the gas at .0002%.3 Much of this irritation is centered on the diaphragmatic region. Also, remember to drink lots of fluids and avoid constipation. after a few days. Excess fluid or blood clots trapped in the upper abdomen and between the diaphragm and right . Ask a doctor any question online now and get answers within minutes. In fact, ISB may benefit this subset of patients. Principal Investigator: Hsiao-Wen Tsai, M.D. We would love to hear from you. 24/7 visits - just $39! Each time you eat a fatty meal, it aggravates the nerve and causes referred pain in your right shoulder blade. Experiments with gases other than CO2 i.e., helium, nitrous oxide and argon have all produced the same or similar effect. EMSJen. You can also try leg exercises to stimulate your bowels. Co2 was removed by passive exsufflation through the port site. the pain. Shoulder pain is a common side effect after laparoscopic surgery. This is often due to residual gas that may be trapped under the diaphragm. Elevating your head on a pillow can reduce pain. Accessibility Muscular disorders, such as muscular dystrophy. The incidence of shoulder pain varies from 35% to 80% and ranges from mild to severe. Usually, this is caused by severed, stretched, or compressed nerves. Pain in the right shoulder and arm is often due to muscle or tendon damage. One type of pain that is unique to laparoscopy is the post laparoscopy shoulder pain due to the phrenic nerve irritation to the diaphragm caused by the CO 2 gas that remains in the abdomen at the end of the procedure.When the patient sits up, the gas moves upwards to the diaphragm and irritates the shoulder. The upper part of the abdominal cavity was evenly and bilaterally filled with the 0.9% normal saline in the amount of 500cc we will leave the fluid in the abdominal cavity. Docusate sodium may help you regain control of your bowel movements. Consult Now. If If your shoulder pain after a minimal access surgery is due to internal What can you not do after laparoscopic surgery. They need to know whether your intestines are functioning well, and if any POIs are occurring. Still; even in the best of hands with use of the most meticulous techniques, some shoulder pain may persist - though it should begin declining markedly around the 48 hour mark.8 Anecdotal tips for coping include applying a heating pad to the affected shoulder, alternating between lying flat or on your side and ambulating (walking around), judicious use of post-operative analgesia, use of over the counter medications like GasX and consumption of hot liquids such as tea. Share it! and rising up to under the diaphragm, causing the same type of irritation eCollection 2021. Phrenic nerve irritation If your phrenic nerve becomes irritated or damaged, you may lose the ability to take automatic breaths. You can expect gas pains for several days following surgery. The hypothesis of post-operative shoulder-tip pain is that carbon dioxide induced phrenic nerve irritation causes referred pain to C4. be able to work. Randomised prospective study comparing the incidence of postoperative pain after phrenic nerve infiltration vs non-phrenic nerve infiltration on open thoracotomy - initial results Clipboard, Search History, and several other advanced features are temporarily unavailable. Cholecystectomy; Laparoscopic; Nerve block; Phrenic nerve; Shoulder pain; Ultrasonography. This article will discuss how to relieve phrenic nerve pain after surgery. government site. After laparoscopic surgery, its common to experience pain in the diaphragm area. World Laparoscopy HospitalCyber City, Gurugram, NCR Delhi INDIA : +919811416838World Laparoscopy Training InstituteBld.No: 27, DHCC, Dubai UAE : +971525857874World Laparoscopy Training Institute8320 Inv Dr, Tallahassee, Florida USA : +1 321 250 7653, Paid Online Consultation From Our Surgeon, shoulder pain, as the gas can irritate your diaphragm (the muscle you use to breathe), which in turn can irritate nerve endings in your shoulder. remain. The Use of Massage Therapy as a Nonpharmacological Approach to Relieve Postlaparoscopic Shoulder Pain: a Pediatric Case Report. shoulder pain is said to be phrenic nerve-mediated . What causes irritation of the phrenic nerve? Abdominal surgery can sometimes lead to chronic pelvic or abdominal pain. Flying after laparoscopic surgery. There is a high incidence of shoulder pain after visceral surgical procedures. Additionally, hot tea can stimulate gastrointestinal motility and help you relieve painful gas pains. Each person has a different overall response, and hair loss can come and go throughout your life, but there is no known cure bleeding, this can easily be identified because you will feel very weak, your Here, we investigated whether a phrenic nerve block (PNB), performed under ultrasound guidance, could reduce the incidence and severity of PLSP after laparoscopic cholecystectomy. lost a significant amount of blood, filling the whole of the abdominal cavity, This website is for information purpose only. Unfortunately, the use of carbon dioxide (CO2) to insufflate the abdomen is the main contributor to post-operative shoulder pain. Image (c) by www.laparoscopy.am. The procedure has a number of benefits, including shorter hospitalization, fewer incisions and less post-operative pain. Please do not contact our surgeons or staff via text/SMS on their personal cell phones or by social media/messenger. The phrenic nerve is important for breathing and has both sensory and motor functions. This clinical controlled trial is tried to find out the practical and clinical maneuver to reduce post-operative should-tip pain following laparoscopic surgery. Here, we investigated whether a phrenic nerve block (PNB), performed under ultrasound guidance, could reduce the incidence and severity of PLSP after . shoulder - what doctors call referred pain. While it can be uncomfortable, the pain will pass on its own. Depending on the extent of the surgery, the pain can last for up to 72 hours. Keywords: Lastly, you may want to consider using abdominal support pillows. and rises to stay under the diaphragm. Listing a study does not mean it has been evaluated by the U.S. Federal Government. This pain may last for a few days. In many cases, it can be treated with numbing agents. However, shoulder pain can be caused by stretching of the shoulder, which is constrained by many muscles and ligaments. It feels like someone is stabbing me with a piece of rebar (the metal poles in concrete) and just . However, there is marked interindividual variability of post-operative shoulder-tip pain following laparoscopic surgery. Shoulder pain after pelvic peritonoscopy can be reduced by both lignocaine or bupivacaine i.p., and the addition of adrenaline permitted a large volume to be used without approaching systemic toxicity. eating spicy foods. This review presents an overview of the currently evaluated techniques to reduce . However, these effects will quickly wear off. Our Customer Services Team are here to help with all of your inquiries during institute opening hours. The Phrenic Nerve Program is a collaboration between Reza Jarrahy, MD at the UCLA Division of Plastic & Reconstructive Surgery and Matthew Kaufman, MD at the Institute for Advanced Reconstruction. Gas left in the abdomen after laparoscopic surgery can irritate the peritoneum. Recruitment manoeuvres (RM) consist of a ventilatory strategy that increases the transpulmonary pressure transiently to reopen the recruitable lung units in acute respiratory distress syndrome (ARDS). To minimize the pain, they can elevate their head with pillows and avoid lying flat on their back. Right-side diaphragmatic excursion decreased significantly in group P at 1 h postoperatively. Unless the phrenic nerve is injured on both sides, making the patient unable to breathe on his or her own, this is often an elective treatment situation. National Library of Medicine It can also be caused by an inflammatory or autoimmune disease. confused and thinks that the signal of irritation or pain is coming from the Click here to upload more images (optional). Conclusion: Novel Regional Nerve Blocks in Clinical Practice: Evolving Techniques for Pain Management. What caused it? with time this can decrease. -. The test uses a fluoroscope, a special X-ray machine that allows your doctor to see live images of the inside of your body. It is NOT a substitute for seeking a one-to-one professional medical advice. Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number): Why Should I Register and Submit Results? Walking and moving around will help alleviate the discomfort. n of surgical wound, decreasing in postoperative pain, shortening hospital stay, rapid recovery, and a better cosmetic result. This electrode is connected to a radiofrequency receiver which is implanted just under the skin. finding this helpful in overcoming their shoulder tip pain. This clinical controlled trial is tried to find out the practical and clinical maneuver to reduce post-operative upper abdominal and shoulder pain after laparoscopic surgery. pain after laparoscopy, do not hesitate to call your doctor, especially if this All Rights Reserved. Your doctor may order an X-ray to determine the cause. It happens usually due to irritation of diaphragm while passage of bolus of food. After laparoscopic surgery, you will be asked to remove any jewelry near your navel. Therefore, the investigators should try to do is that if the investigators could reduce carbon dioxide retention in the pelvic cavity. View this study on Beta.ClinicalTrials.gov. But be careful not to apply heat packs to the abdomen for more than fifteen minutes at a time. In some cases, the damaged nerve may heal on its own, but patients need to understand this isnt an unlimited window. During this recovery period, you will be extremely tired and need to rest. Graduated from ENSAT (national agronomic school of Toulouse) in plant sciences in 2018, I pursued a CIFRE doctorate under contract with SunAgri and INRAE in Avignon between 2019 and 2022. There is a high incidence of shoulder pain after visceral surgical procedures. Phrenic nerve irritation If your phrenic nerve becomes irritated or damaged, you may lose the ability to . The pain can last for several days, but can be relieved with simple analgesics. Gynaecological keyhole surgery (laparoscopy) is a procedure where a surgeon uses a camera (laparoscope) to see inside the lower abdomen to view the uterus (womb), fallopian tubes and ovaries. Shoulder arthroscopy is a minimally invasive procedure that treats shoulder impingement and rotator cuff tears. Entering your story is easy to do. Severe ISP can cause ineffective breathing and impair shoulder mobilization. However, it is actually caused by cellular death, which is part of the wound-healing process. Although most patients report minimal pain after laparoscopic surgery, about 35 to 70% of patients complain of shoulder pain. passing very little or no urine, and your abdomen will be very distended. Careers. In the neck and upper thorax, the left phrenic nerve tracts proximal to the subclavian artery. diaphragm - the dome shaped muscle under both lungs that separates the chest The https:// ensures that you are connecting to the Postoperative shoulder pain is a common complication of laparoscopic surgery. Choosing to participate in a study is an important personal decision. Firstly, you can avoid pain by taking an over-the-counter analgesic. My surgeon tells me that my diaphram is irritated and the phrenic nerve is causing the pain. Because it is the same nerve that send pain signals to both the shoulder and the diaphragm, the brain is confused and thinks that the signal of irritation or pain is coming from the shoulder - what . Carbon dioxide trapped between the liver and the diaphragm can also cause the familiar upper abdominal/shoulder pain.4Removing or washing out the residual gas does help reduce the incidence and severity of this pain in both the shoulder and upper abdomen. Other possible etiologies of shoulder pain after thoracic surgery are the loss of one of the main bronchi, the position of the patient during surgery, tightening of musculature and the shoulder joint and thoracotomy route . Shoulder pain after laparoscopic surgery has been thought to be due to the irritation of the phrenic nerve, which may be mainly caused by insufflated carbon dioxide. Though more common in children, it can occur in. Multiple research studies have hypothesized that PLSP is due to phrenic nerve irritation at the diaphragmatic level, creating referred pain sensations around the shoulder unilaterally or bilaterally. [2] This nerve has sensory, motor, and sympathetic functions. Later, a pulmonary recruitment maneuver consisting of five manual pulmonary inflations was performed with a maximum pressure oof 60 cmH2O. It exits each side of the spinal cord at three cervical nerve roots in the neck, C3, C4, and C5. The existence and severity of PLSP were assessed for 2 days postoperatively. Bruising after laparoscopic surgery. Just type!Your story will appear on a Web page exactly the way you enter it here. After the surgery, the shoulder is likely to be sore. Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01433874. This problem is often caused by trapped gas under the rib cage. The 5 terminal branches of the brachial plexus are the musculocutaneous, median, ulnar, axillary, and radial nerves. If despite all the above measures you still suffering with this shoulder Usually, the pain occurs on the right side. Studies continue to further improve techniques towards gasless laparoscopy as well, which is currently limited due to increased difficulty, impaired visualization, longer operative times and increased costs.6In our Center, our surgeons are acutely aware of and take extreme concern with the comfort levels of our patients. Current Weight: 178 lbs. weakness and shortness of breath. -, Br J Anaesth. Your phrenic nerve stretches from the abdomen, through the chest, and into your neck. 2008 May;111(5):1155-60. doi: 10.1097/AOG.0b013e31816e34b4. Home Contact Us Privacy Policy Ad Policy DisclaimersStatement of Diversity & Inclusion:The Center for Endometriosis Care (CEC) fosters a culture of opportunity and mutual respect. You should also find the right sitting position to minimize your pain. From its origin, the phrenic nerve descends vertically caudad and adjacent to the internal jugular vein. Most people recover from this procedure in a few days. If the pains dont disappear on their own, try taking a stool softener. After a surgery, residual CO2 gas can irritate this nerve, causing shoulder pain and diaphragmatic pain. 2015 Dec 05;5(6):e31524 Postoperative pain caused by gas is the most common and most unpleasant experience for patients after laparoscopic surgery. Heat packs can also increase swelling, so be sure to take a rest every 20 minutes. Multiple research studies have hypothesized that PLSP is due to phrenic nerve irritation at the diaphragmatic level, creating referred pain Thank you! The right phrenic nerve runs superficial to the anterior . Here, we investigated whether a phrenic nerve block (PNB), performed under ultrasound guidance, could reduce the incidence and severity of PLSP after .