A 27-year-old primigravida at 9 weeks' gestation underwent emergency laparoscopic ovarian surgery under combined spinal-epidural anesthesia. During pneumoperitoneum, bilateral shoulder-tip pain developed after Trendelenburg positioning. Intravenous acetaminophen (1000 mg) was initiated, and pain improved within 10 minutes, allowing surgery to continue without lowering insufflation pressure, administering additional opioids or sedatives, or converting to general anesthesia. Pain resolved after desufflation. Maternal oxygenation remained stable, and fetal cardiac activity was reassuring before and after surgery. This case suggests that intravenous acetaminophen may be an opioid-sparing rescue option for intraoperative shoulder-tip pain during awake laparoscopy in early pregnancy.
Akashi et al. (Fri,) studied this question.