Post-operative gas pains

[Double-Helix, BSN, RN]

What are the best ways to relieve post-operative gas pains from laparoscopic surgeries and open abdominal surgeries? Some of our kiddos even complain of pain in the neck/shoulders where the gas has escaped. The physiology behind this still confuses me. Aside from frequent ambulation and pain medication, what can be done for these pains?

[roser13, ASN, RN]

It's my understanding that the CO2 bubbles left over in the abdomen begin to rise (with the first post-OP ambulation/movement) to the level of the diaphragm. Diaphragmatic ennervation extends to the left shoulder, transmitting the pain signals.

All I've ever known to do is administer the usual post-op pain meds and explain that the bubbles will eventually dissipate on their own. I've also found it valuable to explain that the "gas" is not the traditional kind that can be expelled easily in the "usual" way.

[Pepper The Cat, BSN, RN]

Fart?

I remember in the old days before lap surgeries, dragging pts out of bed and making them walk so they could "pass gas"

[brownbook]

Same here, nothing I have heard of specific to relieve CO2 bubble pain. Sometimes they hurt worse than the incisional pain. No reason not to give pain meds.

I did have a patient swear she drank warm milk and the pain went away? At least it is a harmless intervention.

[PunkBenRN]

Pepper The Cat said:

Fart?

I remember in the old days before lap surgeries, dragging pts out of bed and making them walk so they could "pass gas"

I think the poster is referring to the gas related to laproscopic procedures, not flatulence after surgery. When a laproscopic procedure is done, they employ cameras within the area; in an abdomnial procedure, it is necessary to "inflate" the area, so the lense isn't constantly covered. What results are gas pains after surgery, typically in the shoulders/neck, as the gas forms bubbles and rises. Some patients, I have found crepitus even.

As far as what to do about it, I've tried a few things but nothing reliable enough to promote. Honestly, the best thing for it is time - if they can bear it, a day or two it tends to absorb back into the body.

[K+MgSO4, BSN]

If your pt is getting right side pain,lie on the right side after pain relief and the gas will disperse to the left a bit. Visa versa.

The gas cannot escape to you shoulder :) that's anatomically impossible. It's a bad expression that we use all the time as well. It is due to the nerve supplying you left shoulder also supplies your diaphragm. It can be seen classically in gallstone pancreatitis.

[PunkBenRN]

I'm confused about how that is anatomically impossible; is it an issue of the mesentery, or diaphragm? What is in the way? How does crepitus develop? The pressure on the nerve makes sense in this instance.

I have also had patients switch sides before, good advice

[nurseprnRN, BSN, RN]

PunkBenRN said:

I'm confused about how that is anatomically impossible; is it an issue of the mesentery, or diaphragm? What is in the way? How does crepitus develop? The pressure on the nerve makes sense in this instance.

I have also had patients switch sides before, good advice

Referred pain up under the shoulder is from irritation of the diaphragm from leftover gas in the abdomen. As the gas is (gradually) absorbed into the capillary bed in the peritoneum, it will, um, pass, But not as flatus. The more you shift around, the faster it gets absorbed and the sooner it stops bothering you. It's harmless, just obnoxious.

Crepitus is the result of air or gas in tissues. If somebody pops a pneumothorax and has air escape into the subcutaneous tissues, they get puffy and it feels like a baggie full of milk and Rice Crispies, or maybe teeny-weeny bubble wrap, to your palpating fingertips-- you can push the air around under there :). This is not generally that painful in my experience but can get serious if it's so big that it impedes breathing or other structures. After the air leak is repaired or healed, the subq air gets absorbed into the capillaries and the swelling goes down.

If the crepitus is a result of gangrenous tissue (they don't call it "gas gangrene" for nothin') it still feels like the Rice Crispies/bubble wrap to you but can be exquisitely painful to the patient, related to the dying tissue.

Crepitus is also the term used for the sort of crunchy feeling of a broken bone moving around. Nothing to do with air or gas, just that sorta crackly, crunchy thing.

None of these are what the OP was describing, though.

[PunkBenRN]

Thanks for explaining

[Double-Helix, BSN, RN]

Thank you. I think I mean the referred pain from the diaphragm nerve (Phrenic nerve, I think). But I did remember a patient from nursing school who has serious crepitus in his neck, but I remember now that he was post-op a lobectomy, so a different surgical area. I appreciate the insight here. It looks like ambulation, pain mediation and time is really the only solution.

[MomRN0913]

I had a lap chole a few months ago and I had the classic gas pains radiating to shoulder. They told me to walk and I did, but it didn't work much. I also laid on the opposite side of where the pain was.It definitely was the worst part of the surgery. Pain meds did help though

[Vespertinas]

'You mean there isn't a pill I can take for this??"

hehe