Obstet Gynecol Sci.  2020 Mar;63(2):187-194. 10.5468/ogs.2020.63.2.187.

Combination of a pulmonary recruitment maneuver and intraperitoneal bupivacaine for the reduction of postoperative shoulder pain in gynecologic laparoscopy: a randomized, controlled trial

• Cho M
• Kim CJ
• Hahm TS
• Lee YY
• Kim TJ
• Lee JW
• Kim BG
• Bae DS
• Choi CH

• KMID: 2471757
• DOI: http://doi.org/10.5468/ogs.2020.63.2.187

Abstract

OBJECTIVE
To compare the efficacy of a pulmonary recruitment maneuver using lower airway pressure (30 cm H2O) and intraperitoneal bupivacaine, alone or in combination, for reducing shoulder pain after gynecologic laparoscopy.
METHODS
A prospective controlled study was performed in a teaching hospital with patients who underwent elective gynecologic laparoscopic surgery. Two hundred eighty-seven patients were randomized into 1 of 4 groups: group A, placebo; group B, intraperitoneal instillation of bupivacaine; group C, CO2 removal by a pulmonary recruitment maneuver; group D, combination of intraperitoneal bupivacaine and pulmonary recruitment maneuver. The interventions were performed at the end of surgery. Shoulder pain was recorded on a visual analog scale (VAS) at 1, 6, 12, and 24 hours postoperatively.
RESULTS
The overall incidence of shoulder pain was 49.8% and the incidence tended to gradually decrease from group A to group D (59.0% in group A, 54.8% in group B, 44.4% in group C, and 41.5% in group D; P=0.026). In addition, the VAS scores gradually decreased from group A to D, although a statistically significant difference was only found at 6 hours postoperatively (P=0.03). There were no complications related to the interventions.
CONCLUSION
The combination of a pulmonary recruitment maneuver with intraperitoneal bupivacaine significantly reduced shoulder pain after gynecologic laparoscopy. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01039441

Keyword

Gynecologic laparoscopy; Intraperitoneal bupivacaine; Pulmonary recruitment maneuver; Shoulder pain; VAS score

MeSH Terms

Bupivacaine*
Hospitals, Teaching
Humans
Incidence
Laparoscopy*
Prospective Studies
Shoulder Pain*
Shoulder*
Visual Analog Scale
Bupivacaine

Figure

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  Fig. 1 Flowchart of randomization and group allocation.

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  Fig. 2 Intensity of shoulder pain recorded using a visual analogue scale (VAS) at 1, 6, 12, and 24 hours after surgery in group A (control); group B (intraperitoneal instillation of bupivacaine alone); group C (pulmonary recruitment maneuver alone); and group D (intraperitoneal instillation of bupivacaine combined with pulmonary recruitment maneuver).

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