Exercise Your Shoulder Pain-free
After a laparoscopic cholecystectomy, provide discharge instructions to a family member or another responsible adult, as well as to the patient, because the patient goes home within 24 hours after surgery. Explain the possibility of abdominal and shoulder pain because of the instillation of carbon dioxide to prevent anxiety about a heart attack if the pain occurs. Teach the patient to avoid submerging the abdomen in the bathtub for the first 48 hours, to take the prescribed antibiotics to provide further assurance against infection, and to watch the incisions for signs of infection. Following a 3- to 5-day hospital stay for an open cholecystectomy, instruct the patient on the care of the abdomen wound, including changing the dressing and protection of any drains.
Informed consent must be obtained with discussion of possible complications, including conversion to an open surgical approach owing to failure to progress or vascular injury or bowel injury, postoperative paresthesias (i.e., brachial plexus of downside arm, sciatic stretch injury of upside leg), occult bowel injury, transient shoulder pain associated with the pneumoperitoneum, subcutaneous emphysema, and other potential problems associated with laparoscopy. Also mentioned is the possibility of mortality owing to a gas embolus, although chances of this occurring are in the range of 1 in 10,000. The patient is typed but not cross-matched for blood. Prior to the procedure, a chest radiograph and a computed tomography (CT) scan (with and without contrast) are obtained as part of a metastatic evaluation. The CT scan is scrutinized to rule out the following liver metastases, lymphadenopathy, renal vein or vena caval involvement and to assess the adrenal glands. Preoperative blood work...
Establish a history of persistent cough, chest pain, dyspnea, weight loss, or hemoptysis. Ask if the patient has experienced a change in normal respiratory patterns or hoarseness. Some patients initially report pneumonia, bronchitis, epigastric pain, symptoms of brain metastasis, arm or shoulder pain, or swelling of the upper body. Ask if the sputum has changed color, especially to a bloody, rusty, or purulent hue. Elicit a history of exposure to risk factors by determining if the patient has been exposed to industrial or air pollutants. Check the patient's family history for incidence of lung cancer.
In a recent study by Hoznek et al., the mean dose of morphine and the mean duration of its administration was 53.1 and 44.4 lower, respectively, after extraperitoneal than after transperitoneal radical prostatectomy. Although the difference was not statistically significant, the authors considered it clinically relevant. In addition, abdominal tenderness and shoulder pain, commonly observed among LRPE patients, were not reported in their extraperitoneal series 11 .
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