Comparision of the effect of Subdiaphragmatic Saline and sodium- bicharbonate Irrigation for Reducing Postoperative Shoulder Pain after Laparoscopic hysterctomy Surgeries

Comparison of the effect of sub-diaphragmatic injection of sodium bicarbonate with normal saline on shoulder pain

The clinical trial has a control group with parallel groups of 2 treatment groups, double-blind, and randomized, 90 patients and a control group based on block randomization.

After the injection of sodium bicarbonate and normal saline at the end of the operation, the presence and intensity of shoulder pain will be measured and recorded based on the VAS visual pain scale during recovery and at 12, 24 and 48 hours after surgery. If there is pain Shoulders with VAS greater than or equal to 4 and additional painkillers including diclofenac suppositories were given to the patients and finally the amount of additional painkillers received to improve shoulder pain within 24 hours after the operation will be recorded in the patients. And 3 groups will be compared with each other.

Elective laparoscopic hysterectomy surgery,ASA 1 and 2, absence of allergy to sodium bicarbonate, liver and kidney dysfunction, heart disease, shoulder pain or myofascial pain, absence of cognitive impairment

In the first group (saline group): during surgery, 500 cc of normal saline under the right hemodiaphragm before The removal of carbon dioxide . In the second group (sodium bicarbonate group), 50 cc of bicarbonate Sodium 7.9% in 500 cc of normal saline 0.9% at the end of the surgery to the same.And in the control group (group 3) no intervention will be done.

shoulder pain and the amount of receiving additional painkillers

All patients undergo laparoscopic hysterectomy by a team of surgeons. And the intervention will be done based on the block randomization list by the operating room technician, and after random assignment, the patients will be divided into 3 groups. Randomization in this study is done in the form of block randomization. Randomly permuted blocks (block size of 3) will be generated using the website www.sealedenvelope.com and will be written on the drug envelopes. After receiving the consent form and after confirming the eligibility of the patient, the random code will be randomized based on the randomization sheet by the main researcher and based on a predetermined randomization plan in the ratio of 1:1:1 to receive drug or serum or control. and receive their corresponding intervention box. This number was considered as the participant's randomization code and will be identified with this number until the end of the study. Randomization using closed envelopes based on the type of medicine is given to the operating room technician and then the patients are followed up.

After obtaining informed consent from the patient to participate in the study, the patient will not know the type of intervention he received. In order to hide the random allocation process, the sequence of treatments will be written on the cards in order, then the cards will be placed in sealed envelopes. A 10-digit random code will be written on each envelope without any order or frame, which is the identification number of the relevant patient, and only one of the executive agents of the project, who will not be involved in the evaluation, analysis and interpretation of the results, will be aware of the relevant code. When another doctor (clinical caregiver) declares the eligibility of a patient, the nurse provides the envelope to the doctor and the desired surgical intervention will be performed based on the type mentioned in the envelope. And the results of the study will be checked by a outcome assessor who is unaware of the type of intervention. Due to the anesthesia during the surgery, the patients will not know the type of intervention. The statistics analyzer and the researcher will not be aware of the type of medicine used.