Springvale Cemetery Upcoming Funerals, Mark Attanasio Family, Articles P

Image (c) by www.laparoscopy.am. Warm bath and hot drink. PATIENTS COMPLAIN OF: radiating pain in the chest and back. Fortunately, newer techniques are making it easier to manage this condition. American Society of Anesthesiologists(ASA) physical status of patient classification I-II. It can also occur as a result of damage to the peripheral nerves in those areas. The upper part of the abdominal cavity was evenly and bilaterally filled with the 0.9% normal saline in the amount of 500cc. be able to work. There are 11 strategies that are used to minimize the pain after laparoscopic surgery. A pulmonary recruitment maneuver consisting of five manual pulmonary inflations was performed with a maximum pressure of 60 cmH2O. These may feel like sharp pains in your abdominal area or pelvis. This type of pain would not go away You can take up to Flying after laparoscopic surgery. SURGERY for shoulder pathology is increasingly common, 1,2 with regional anesthesia playing an important role in multimodal analgesia for these painful procedures. Therefore, the investigators should try to do is that if the investigators could reduce carbon dioxide retention in the pelvic cavity. Choi YM, Byeon GJ, Park SJ, Ok YM, Shin SW, Yang K. J Clin Anesth. It may also help to rock your knees from side to side. Usually, the pain occurs on the right side. In fact, the acid milieu created by the dissolution of CO. 2. gas causeperitoneal irritation and phrenic nerve The authors describe the anatomical, physiologic, and clinical principles relevant to phrenic nerve palsy in this context and present a comprehensive review of the strategies for reducing phreno-nerve palsy and its clinical impact while ensuring adequate analgesia for shoulder surgery. Diagnosing traumatic diaphragmatic rupture (TDR) due to penetrating rib fractures is challenging because the lesions are often too small to be detected and may present years after injury. Here, we investigated whether a phrenic nerve block (PNB), performed under ultrasound guidance, could reduce the incidence and severity of PLSP after . The saphenous nerve is the sensory component of the femoral nerve after it enters the adductor canal, and it provides sensory innervation to the medial aspect of the ankle. Home Contact Us Privacy Policy Ad Policy DisclaimersStatement of Diversity & Inclusion:The Center for Endometriosis Care (CEC) fosters a culture of opportunity and mutual respect. Walking and moving around will help alleviate the discomfort. Pain occurs in the neck or scapula when the phrenic nerve is irritated 16,17,22. . After the surgery, the shoulder is likely to be sore. This can be too painful for some people, however. should go away within 3 - 5 days. Shoulder pain after laparoscopic surgery has been thought to be due to the irritation of the phrenic nerve, which may be mainly caused by insufflated carbon dioxide. (You can preview and edit on the next page), Help Keep This Site GoingDonate To Show Your Support, Return To Home Page from Shoulder Pain After Laparoscopy Page, YOUR GUIDE TO CAUSES AND TREATMENT OF ABDOMINAL PAIN, Upload 1-4 Pictures or Graphics (optional), Hi, About 18 months ago I had to call an ambulance as I had severe pain in my abdomen on the left side. This referred type of pain is a major concern for patients after laparoscopic surgery, as it can cause patient dissatisfaction and even serious complications such as pulmonary issues. Some clinical trial studies determined that Pulmonary Recruitment Maneuvers and Intraperitoneal Normal Saline Infusions (INSI) reduced shoulder pain; with INSI proving a superior method.5 Preemptive analgesia is also helpful. Severe ISP can cause ineffective breathing and impair shoulder mobilization. Many times the symptoms are temporary, for example, many patients have nerve problems after surgery that only last for a few weeks to months . . You can also try leg exercises to stimulate your bowels. A variety of factors can irritate the phrenic nerve, including: swallowing and breathing air in at the same time. You may also be prescribed an antibiotic. Accessibility You can use ibuprofen or Tylenol to help you deal with the discomfort. Background Post-laparoscopic shoulder pain (PLSP) frequently follows a laparoscopic cholecystectomy. Why Does your shoulder hurt after a laparoscopy? Current Weight: 178 lbs. However, shoulder pain can be caused by stretching of the shoulder, which is constrained by many muscles and ligaments. I'm 3 1/2 weeks out, and I haven't had any issues for . A phrenic nerve is made up of axon fibers that originate in the neck and travel to the diaphragm. Phrenic nerve irritation, following a laparoscopic surgery, can impact both motor and sensory functions. notice this pain in the first day, but it develops gradually and become severe However, these effects will quickly wear off. Your doctor may use dissolvable stitches to close the incisions. 2015 Dec 05;5(6):e31524 Obstet Gynecol. A proposed mechanism for PLSP is the irritation or injury of the phrenic nerve by the CO2 pneumoperitoneum during laparoscopic surgery. If it doesn't control your pain, tell your doctor or nurse. With ultrasound guidance, all PNBs were performed successfully in group P. In group P, the overall incidence and severity of PLSP decreased significantly. Dr.Matthew Kaufman has pioneered state-of-the-art treatment for phrenic nerve injury which reverses diaphragm paralysis. Yi-Jen, Chen, M.D., Ph D., Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, The severity and frequency of upper abdominal and shoulder pain after laparoscopic surgery [TimeFrame:The first 48 hours after the surgery], nausea or abdominal fullness after laparoscopic surgery [TimeFrame:The first 38 hours after the surgery], Patients receive benign gynecological laparoscopic surgery. eCollection 2021 Aug. Kim HY, Choi JB, Min SK, Chang MY, Lim GM, Kim JE. How do you get rid of phrenic nerve pain? Nerves Regulate Breathing The phrenic nerve is actually a pair of nerves, the right and left phrenic nerves, that activate contraction of the diaphragm that expands the thoracic cavity. You can expect gas pains for several days following surgery. 2006 Nov;30(11):1969-73. doi: 10.1007/s00268-005-0752-z. It is an interesting nerve as it is actually two separate nerves on each side of the body, even though it is typically referred to as one nerve. First, try to relax. Please remove one or more studies before adding more. We would love to hear from you. EMSJen. However, if you find that the pain persists, you can take pain medication that your doctor prescribed. It exits each side of the spinal cord at three cervical nerve roots in the neck, C3, C4, and C5. Its a SEVERE stabbing pain in the right shoulder/neck/arm due to damage or scarring on your diaphragm. World Laparoscopy HospitalCyber City, Gurugram, NCR Delhi INDIA : +919811416838World Laparoscopy Training InstituteBld.No: 27, DHCC, Dubai UAE : +971525857874World Laparoscopy Training Institute8320 Inv Dr, Tallahassee, Florida USA : +1 321 250 7653, Paid Online Consultation From Our Surgeon, shoulder pain, as the gas can irritate your diaphragm (the muscle you use to breathe), which in turn can irritate nerve endings in your shoulder. Irritation to the diaphragm may cause a person to feel pain in the shoulder area. National Library of Medicine The doctor may recommend that you take a pain medication to help you recover. Provided for educational purposes only. The phrenic nerve arises from the neck (C3-C5) and innervates the diaphragm, which is much lower. after a few days. However, there are still up to 80% of patients after laparoscopic surgery complaining of high levels of pain and needing pain relief. Score: 5/5 (66 votes) . Try using two heating padsone on the front and one on the back of the affected shoulder. You can also try rocking your knees from side to side. This problem is often caused by trapped gas under the rib cage. However, this gas can also irritate the nerves and affect the physiology of the surrounding peritoneal tissue.It was once believed the resultant shoulder pain was simply due to reaction of the gas combining with water, or that it was merely trapped CO2. However, the actual cause of the irritation is the result of cellular death (not as formidable as it sounds - this is simply a direct response to tissue injury, considered part of the wound-healing process itself) caused by the combination of a temperature change from the gas at 70F and the drying effect of the gas at .0002%.3 Much of this irritation is centered on the diaphragmatic region. Elevation is another helpful method. Score: 5/5 (66 votes) . Another easy way to alleviate the gas pain is to apply a heat pack to the abdominal area. Gas pain after laparoscopic surgery will likely last for a few days after surgery. There is a high incidence of shoulder pain after visceral surgical procedures. Rather, the sufferer would deteriorate if nothing is done. Here, we investigated whether a phrenic nerve block (PNB), performed under ultrasound guidance, could reduce the incidence and severity of PLSP after . Phrenic nerve pain is a complication of laparoscopic surgery. The .gov means its official. One way to relieve phrenic nerve pain after surgery is to drink lots of water and use heat packs. Evidence suggests that shoulder pain after laparoscopy mainly occurs due to the irritation of the afferent nerve fibers of the diaphragm phrenic nerve, induced by the residual CO 2 , blood, or . My surgeon tells me that my diaphram is irritated and the phrenic nerve is causing the pain. The phrenic nerve is one of the four major nerves that run through the diaphragm. Gynaecological keyhole surgery (laparoscopy) is a procedure where a surgeon uses a camera (laparoscope) to see inside the lower abdomen to view the uterus (womb), fallopian tubes and ovaries. Excess fluid or blood clots trapped in the upper abdomen and between the diaphragm and right . You can also keep a pillow under your abdomen to support it. It causes sharp chest pain when breathing, along with shortness of breath. Effects . Our Customer Services Team are here to help with all of your inquiries during institute opening hours. weakness and shortness of breath. The etiology of pain after laparoscopic cholecystectomy is multifactorial (9). on day 3 and then starts getting better by day 5. It is NOT a substitute for seeking a one-to-one professional medical advice. The nerve run downs the neck to the diaphragm, but also branches out to the left shoulder - so the feeling of pain is mistakingly referred out there when the diaphragm . The hypothesis of post-operative shoulder-tip pain is that carbon dioxide induced phrenic nerve irritation causes referred pain to C4. Current Weight: 189 lbs. So the presented cases may actually underestimate the prevalence of hemidiaphragm paralysis after shoulder surgery. You can learn how to deal with the discomfort following your surgery, including what to do about trapped gas, how to sleep after laparoscopy, and more. On seating up or standing or walking, the remaining gas bubbles forth However, if you feel some discomfort after the surgery, you should talk to your doctor. Seating up, standing and walking worsens Alternatively, try gently pushing yourself to have a bowel movement. This video demonstrates surgical repair of the phrenic nerve in a patient diagnosed with right diaphragm paralysis resulting from a prior neck surgery. Co2 was removed by passive exsufflation through the port site. A simple clinical maneuver to reduce laparoscopy-induced shoulder pain: a randomized controlled trial. This will help prevent shoulder pain. Method: A phrenic nerve stimulator is implanted surgically by placing an electrode behind the phrenic nerve, either in the neck or in the chest. The existence and severity of PLSP were assessed for 2 days postoperatively. I had the hernia repair as well, and I was banded on 2/18/11. Other treatment options include orthobiologics and physical therapy. Copyright 2005-2020. -, Br J Anaesth. It may also settle up under the diaphragm, where the CO2 will cause irritation to the chest. You can also apply a heating pad on the affected shoulder to minimize the pain and discomfort. If you have been diagnosed with a paralyzed diaphragm, you may be a . Has anyone dealt with, dealing with phrenic nerve pain? The phrenic nerve stimulation test, also called the phrenic nerve conduction study, uses electric or magnetic stimulation to the neck to measure the response of the phrenic nerve. February 2001 Volume 7 Issue 1, 6. Shoulder arthroscopy is a minimally invasive procedure that treats shoulder impingement and rotator cuff tears. government site. Sci Rep. 2021 Jan 13;11(1):1052. doi: 10.1038/s41598-020-80289-y. In many cases, it can be treated with numbing agents. The prolonged presence of shoulder tip pain suggests excitation of the phrenic nerve due to irritation of diaphragm by CO2. Congenital defects, which happen at birth and have no known cause. The pain is usually temporary and will go away after a couple of days. The significance of phrenic nerve block was studied in the anesthetic management of laparoscopic cholecystectomy. In some cases, it has been reported to last more than 72 hours after surgery. into the cavity of the abdomen to expand it and create space for the surgeon to Because it is the same nerve that send pain signals to both the shoulder and the diaphragm, the brain is confused and thinks that the signal of irritation or pain is coming from the shoulder - what . 24/7 visits - just $39! The purpose of this study was to compare the . Although laparoscopic surgery results in improved patient satisfaction, a considerable portion of patients have complaints of post-operative shoulder pain. This pain is usually on the right side of the body and is caused by irritation to the phrenic nerve, which originates from the C3-C5 cervical nerves and descends through the thorax to innervate the diaphragm. The condition can be caused by a spinal cord injury, physical trauma, or surgical complications. In obese patients with short neck, . Conclusion: heart rate will be very fast, your blood pressure will be low, you will be will go away on its own after a few days. Although most patients report minimal pain after laparoscopic surgery, about 35 to 70% of patients complain of shoulder pain. World J Surg. Starting Weight: 257 lbs. Another treatment option is to use a massage therapy treatment. If you experience post-op gas pain, you should talk to your healthcare provider as soon as possible. This means that the degenerative damage in your neck can significantly impact the function of one or both vagus nerves. that send pain signals to both the shoulder and the diaphragm, the brain is These include alternating between lying flat and lying on your side, using a heating pad to relieve pain, and taking over-the-counter and post-operative analgesia. the pain. injury to the shoulder or neck. A support pillow can also help. Disclaimer. It is associated with irritation of the phrenic nerve, which originates from the cervical spine and descends through the thorax to innervate the diaphragm. Although this pain is often not a serious side effect, it can be bothersome. Entering your story is easy to do. Choi GJ, Kang H, Baek CW, Jung YH, Kim DR. World J Gastroenterol. But be careful not to apply heat packs to the abdomen for more than fifteen minutes at a time. 3 Interscalene brachial plexus block is the most common regional anesthetic technique; however, phrenic nerve palsy and hemidiaphragmatic paresis have traditionally been inevitable consequences, which limit its utility in the . This is because the supraclavicular nerves have the same cervical nerves origin as the phrenic nerve, C3 and C4. Postoperative analgesic efficacy of single-shot and continuous transversus abdominis plane block after laparoscopic cholecystectomy: A randomized controlled clinical trial. Novel Regional Nerve Blocks in Clinical Practice: Evolving Techniques for Pain Management. These include alternative insufflating gases such as nitrous oxide (N2O) or warmed CO2. The site is secure. Pain in the right shoulder and arm is often due to muscle or tendon damage. For example [my story] would show as my story on the Web page containing your story.TIP: Since most people scan Web pages, include your best thoughts in your first paragraph. It begins at the C3 vertebra, which aligns with the jaw and rotates the neck. Another simple way to reduce the pain is to find a position that is most comfortable. Trapped gas is a common postoperative complaint, and it can persist for months after the surgery. Pleurisy Pleurisy refers to inflammation of the pleura, which is the layer of tissue on the inner side of the chest cavity surrounding the lungs. It provides support and reminds patients not to move their arm. eating spicy foods. . This is done to create and maintain a distended abdomen; a condition called "pneumoperitoneum." After a surgery, residual CO2 gas can irritate this nerve, causing shoulder pain and diaphragmatic pain. double-blind trial of ultrasound-guided phrenic nerve block to prevent shoulder pain after thoracic surgery. Rarely, shoulder pain after laparoscopy could be due to internal Guaranteed. Phrenic nerve irritation If your phrenic nerve becomes irritated or damaged, you may lose the ability to . Sodium Bicarbonate Sub-Diaphragmatic Irrigation Relieves Shoulder Pain After Total Laparoscopic Hysterectomy: A Randomized Controlled Trial. Consult Now. The pain may also spread to the lower neck. (Clinical Trial), Maneuvers to Decrease Upper and Shoulder Pain After Gynecologic Laparoscopic Surgery, Experimental: Pulmonary recruitment maneuver, Experimental: Intraperitoneal normal saline infusion, 20 Years to 80 Years (Adult, Older Adult), Contact: Yi-Jen Chen, M.D.,Ph D. 886-2-2875-7566. 1996 Nov;77(5):576-80 Insuflow confers improved pain control and reduces the need for opioids and antiemetics in the postoperative period by humidifying and warming the CO2 to 95F and 95% relative humidity. 2010 Sep-Oct;35(5):455-7 Before leaving the hospital, you should arrange for someone to drive you home. Multiple research studies have hypothesized that PLSP You should also avoid lying flat on your back. After surgery i keep my patients on pured foods to allow the stomach to heal.. Read More. Anyone who has undergone Laparoscopic surgery knows about that shoulder pain. The gas irritates the diaphragmatic nerves. In the neck and upper thorax, the left phrenic nerve tracts proximal to the subclavian artery. The mechanism of laparoscopy-induced shoulder pain is mainly derived from carbon dioxide retention within the abdomen, subsequently irritating the phrenic nerve and causing referred pain in the C4 dermatome. Acquired defects, which occur as the result of an injury, accident or surgery. Liu L, Xia T, Ji H, Guo Y, Liu J, Du L, Lei D, Han C, Ma T. J Pain Res. Mechanism of pain: The hypothesis of post-operative shoulder-tip pain is that carbon dioxide induced phrenic nerve irritation causes . From its origin, the phrenic nerve descends vertically caudad and adjacent to the internal jugular vein. PMC There are two phrenic nerves, a left and a right one. No content herein may be reproduced without express permission from the CEC.Last Site Update:3/2023. If you can, listen to music with headphones. 286 A . Pain in the right shoulder and arm is often due to muscle or tendon damage. Shoulder pain that erupts after laparoscopic surgery is observed due to rise in carbon dioxide in the abdomen which further exerts pressure on the phrenic nerve. Connect with a U.S. board-certified doctor by text or video anytime, anywhere. A sniff test is an exam that checks how the diaphragm (the muscle that controls breathing) moves when you breathe normally and when you inhale quickly. Each person has a different overall response, and hair loss can come and go throughout your life, but there is no known cure To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor. Shoulder pain after laparoscopic surgery has been thought to be due to the irritation of the phrenic nerve, which may be mainly caused by insufflated carbon dioxide. -, Anesth Pain Med. This can cause pain in the chest, upper chest, and shoulder region. If you our pain is disturbing enough In patients undergoing laparoscopic surgery, carbon dioxide gas that is used during the procedure may irritate the phrenic nerve. If you experience these, try gently massaging your tummy to release trapped gas. You can also fold a pillow to reduce the pain when you breathe. Therefore, the investigators should try to do . In addition, you should drink lots of fluids and avoid constipation. 2021 Nov 30;14:3615-3622. doi: 10.2147/JPR.S338716. Consult privately with the doctor of your choice. Its a type of nerve pain that feels like pins and needles. Moreover, carbon dioxide trapped between the liver and the right diaphragm, irritating the diaphragm, also causes upper abdominal pain . Alternatively, the patient can lie down and watch TV or listen to music. CO2 gas isn't the only source of shoulder pain after laparoscopic surgery. However, recovery time varies depending on the type of surgery. Postlaparoscopic shoulder pain is a common side effect of surgery. The 5 terminal branches of the brachial plexus are the musculocutaneous, median, ulnar, axillary, and radial nerves. Epub 2007 Apr 17. The surgeon may also give you a cleansing enema or oral laxative. Hence, patients suffering spinal cord injuries below the neck are still able to breathe effectively, despite any paralysis of the lower limbs. The upper part of the abdominal cavity was evenly and bilaterally filled with the 0.9% normal saline in the amount of 500cc. Patients should follow a rehabilitation plan that includes physical therapy and exercise. 11 Because data on preexisting phrenic nerve paresis, chronic pain issues, or measures to evaluate the same in the patients mentioned in the . and you really want something to relief it, there are a few things you can do Co2 was removed by passive exsufflation through the port site. It can also be caused by an inflammatory or autoimmune disease. A proposed mechanism for PLSP is the irritation or injury of the phrenic nerve by the CO2 pneumoperitoneum during laparoscopic surgery. This soreness is caused by gas in the shoulder joint, which will go away in two to three days. This will help them recover faster. shoulder pain is said to be phrenic nerve-mediated . Patients with delays in diagnosis of TDR rarely present with orthopaedic-related complaints of pain. Up to 80% of these women may experience shoulder-tip pain (STP), which may be very painful and lead to longer stays in hospital and even having to go . To receive credit as the author, enter your information below. The incidence of pain after laparoscopy may be attributed to the carbon dioxide gas (CO 2) used to induce pneumoperitoneum[13,14]. So your musculature could pinch down and cause a problem with that phrenic nerve. Laparoscopy-induced pain is still not fully understood. You may feel shy about talking about passing gas, but it is important to let your health care team know how it feels. The heat from the heat pack will relax the muscles, which will help the gas move. Simple measures can help relieve pain, including drinking peppermint tea or using a hot pack. Ways To Relieve Pain After Robotic or Laparoscopic Surgery. The phrenic nerve is a bilateral, mixed nerve that originates from the cervical nerves in the neck and descends through the thorax to innervate the diaphragm. Cover photo AJ Arend. However, this pain should pass on its own in a couple of days. Phrenic nerve irritation, following a laparoscopic surgery, can impact both motor and sensory functions. After surgery, you may feel sleepy, so you should try and take frequent naps. The intense sharp pain in the left shoulder is caused by the damage to the phrenic nerve that can sometimes (certainly not always) happen during nissan fundoplication surgery. Lap band surgery also causes shoulder pain. Phrenic nerve irritation, following a laparoscopic surgery, can impact both motor and sensory functions. These pillows can help reduce the discomfort associated with gas pain. After laparoscopic surgery, you will be asked to remove any jewelry near your navel. A proposed mechanism for PLSP is the irritation or injury of the phrenic nerve by the CO 2 pneumoperitoneum during laparoscopic surgery. What can you not do after laparoscopic surgery. Unexplained shoulder and arm pain can sometimes be a warning sign of a heart attack. Background: Post-laparoscopic shoulder pain (PLSP) frequently follows a laparoscopic cholecystectomy. When you register, the WLH reserves specific class space for you and commits resources to provide the Hands On Course you have selected. Pneumoperitoneum is necessary to provide your surgeon with a better view of your organs (you can see an artist's rendering below). For more information or to schedule a consultation, please call (855) 233-3681. . EDITOR: Shoulder pain after laparoscopic surgery has been thought to be due to the irritation of the phrenic nerve, which may be mainly caused by insufflated carbon dioxide .However, shoulder pain can be caused by stretching of the shoulder, which is constrained by many muscles and ligaments .We investigated postoperative shoulder pain in 72 patients who underwent gynaecological laparoscopy by . Listing a study does not mean it has been evaluated by the U.S. Federal Government. This gas can irritate the diaphragm and peritoneum, causing pain and discomfort. Thus, the phrenic nerve receives innervation from parts of both the cervical plexus and the brachial plexus of nerves. Postoperative pain caused by gas is the most common and most unpleasant experience for patients after laparoscopic surgery. with time this can decrease. Goldberg J, Falcone T. Gasless Gynecologic Laparoscopy. Retrieved from http://hcp.obgyn.net/laparoscopy/content/article/1760982/1894615, 6105 PEACHTREE DUNWOODY ROADBUILDING B, SUITE 230ATLANTA, GA 30328PHONE: 770-913-0001FAX: 770-913-0005. When the phrenic nerve is injured, the electrical signals in it stop traveling from the brain to the diaphragm muscle. For me, the pain lasted for about a week, but the shoulder pain was on and off for about another week. Unexplained shoulder and arm pain can sometimes be a warning sign of a heart attack. bleeding. Phrenic neuropathy may be an important, albeit a rare complication of diabetes, and hence, diaphragmatic dysfunction associated with diabetic phrenic neuropathy should be considered in any patient with unexplained breathlessness, orthopnea, and respiratory failure. Later, a pulmonary recruitment maneuver consisting of five manual pulmonary inflations was performed with a maximum pressure oof 60 cmH2O. What causes irritation of the phrenic nerve? Have as much rest as possible. and rises to stay under the diaphragm. However, one disadvantage of the procedure is that patients are more likely to experience shoulder pain. Combined low pressure pneumoperitoneum and intraperitoneal infusion of normal saline for reducing shoulder tip pain following laparoscopic cholecystectomy. You can use paracetamol or ibuprofen for the pain you experience following surgery. After a laparoscopic surgery, your shoulder may hurt. After four hours, you can begin walking or at least climbing stairs. Similarly, other gases can cause similar symptoms. Second, spend some time alone. Do you have some pictures or graphics to add? Bookshelf The phrenic nerve contains afferent nerve fibers from the pleura and peritoneum. We will leave the fluid in the abdominal cavity. Passing gas after surgery is completely normal, and its a good sign. Cellular Death a normal, regular process by the body to deliberately get rid of unwanted cells, C02 a colorless, odorless gas comprised of one carbon and two oxygen atoms abdominal cavity, Laparoscopy - a minimally invasive surgical procedure used to diagnose and treat endometriosis (among many other disorders), Peritoneal tissue the membrane that forms the lining of the abdominal cavity, Phrenic Nerve innervates the diaphragm and is responsible for, among other functions, breathing, Pneumoperitoneum - surgical creation of a distended abdomen to lift and separate organs (non-surgical pneumoperitoneum = free air in the peritoneal cavity; this is a secondary health concern not addressed or in any way referred to within this article), 1., 4., 5. The phrenic nerve has anatomical connections with the brachial plexus and the shoulder.