Targeting G-protein coupled receptors in the spinal dorsal horn for prevention of shoulder tip pain with cesarean section; a myth or a fact

Abstract

Background & objective: Shoulder tip pain (STP) is a commonly observed, annoying and mostly neglected consequence of cesarean section and little is known as well as explored about intraoperative shoulder pain. We studied the effectiveness of activation of G protein-coupled receptors (GPCRs), by adding intrathecal fentanyl to the spinal anesthesia as a preventive analgesia for shoulder pain with cesarean section (CS).

Methodology: A total of 44 parturients undergoing elective CS were divided into two equal groups; Group F patients received 2.5 ml of hyperbaric bupivacaine 0.5 % and 25 µg fentanyl. Group C (control group) patients received 2.5 ml of hyperbaric bupivacaine 0.5. The incidence and severity of intraoperative STP was noted. The severity of that pain was assessed using the verbal numerical rating scale (0-10) at the time of complaint. The STP was monitored every 2 h for 8 h postoperatively.

Results: There was no statistical difference in the incidence and severity of STP in both groups. The average for diastolic blood pressure was 74 ± 6.5 mmHg in Group C vs 72 ± 8.5 mmHg in Group F and the average for the heart rate was 84 ± 6 bpm vs 79 ± 12 bpm in Group C and F respectively. Point biserial correlation revealed a positive correlation (0.3) between t STP and total blood loss; however, this correlation wasn’t statistically significant (P = 0.06).

Conclusion:  Activation of G protein linked receptor by adding fentanyl to the local anesthetic for spinal anesthesia decrease the incidence of shoulder tip pain; however, the difference is statistically insignificant.

Abbreviations: CS - cesarean section; GPCR - G protein-coupled receptor; STP - Shoulder tip pain

Keywords; Anesthesia, spinal; Cesarean section; Pain; Pain, postoperative; Pain, shoulder tip; fentanyl; G protein-coupled receptors.

Citation: Haggag AM, Kamel WY. Targeting G-protein coupled receptors in the spinal dorsal horn for prevention of shoulder tip pain with cesarean section; a myth or a fact. Anaesth. pain intensive care 2024;28(2):285−290; DOI: 10.35975/apic.v28i2.2436

Received: July 24, 2023; Revised: December 20, 2023; Accepted: January 31, 2024