Obstet Gynecol Sci.  2024 Mar;67(2):253-260. 10.5468/ogs.23197.

Additional low-pressure pulmonary recruitment for reducing post-laparoscopic shoulder pain in gynecologic laparoscopy: a randomized controlled trial

• Temtanakitpaisan A
• Temtanakitpaisan T
• Pratipanawatr C
• Buppasiri P
• Somjit M

• KMID: 2553433
• DOI: http://doi.org/10.5468/ogs.23197

Abstract

Objective
To evaluate the effectiveness of additional low-pressure pulmonary recruitment in reducing postoperative shoulder pain.
Methods
A double-blind randomized controlled trial was conducted at Srinagarind Hospital between May 2021 and October 2021. Forty patients who underwent laparoscopic gynecologic surgery were randomized into either an intervention group that received additional low-pressure pulmonary recruitment (30 cmH₂O) (n=20) or a control group (n=20). Shoulder pain was evaluated using a numerical rating scale from 0 to 10, 24, and 48 hours after the operation.
Results
The mean±standard deviation of shoulder pain at 24 hours after the operation of both the intervention and control groups were 2.10±2.27 and 1.45±1.73 points, respectively. The shoulder pain at 48 hours after the operation of the intervention and control groups were 1.15±1.46 and 0.85±1.73 points, respectively. There were no statistical differences in the mean difference between the two groups at 24 and 48 hours after operation (P=0.49; 95% confidence interval [CI], -0.61 to 1.91 and P=1.00; 95% CI, -0.96 to 1.56, respectively). No statistically significant differences were observed in additional analgesic medications used in either group, such as intravenous morphine or oral acetaminophen.
Conclusion
Additional low-pressure pulmonary recruitment to reduce shoulder pain after laparoscopic surgery for benign gynecologic diseases did not show a significant benefit compared to the control group, especially when administering postoperative around-the-clock analgesia.

Keyword

Gynecologic diseases; Laparoscopic surgery; Pulmonary recruitment maneuver; Shoulder pain

Figure

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  Fig. 1 Flow diagram of trial recruitment and follow-up evaluation.

Reference

References

1. Sao CH, Chan-Tiopianco M, Chung KC, Chen YJ, Horng HC, Lee WL, et al. Pain after laparoscopic surgery: focus on shoulder-tip pain after gynecological laparoscopic surgery. J Chin Med Assoc. 2019; 82:819–26.

2. Deura I, Shimada M, Azuma Y, Komatsu H, Nagira K, Sawada M, et al. Comparison of laparoscopic surgery and conventional laparotomy for surgical staging of patients with presumed low-risk endometrial cancer: the current state of Japan. Taiwan J Obstet Gynecol. 2019; 58:99–104.

3. Saha S, Roy KK, Zangmo R, Das A, Bharti J, Rai R, et al. Gynecological laparoscopic surgeries in the era of COVID-19 pandemic: a prospective study. Obstet Gynecol Sci. 2021; 64:383–9.

4. Ortenzi M, Montori G, Sartori A, Balla A, Botteri E, Piatto G, et al. Low-pressure versus standard-pressure pneumoperitoneum in laparoscopic cholecystectomy: a systematic review and meta-analysis of randomized controlled trials. Surg Endosc. 2022; 36:7092–113.

5. Radosa JC, Radosa MP, Schweitzer PA, Radosa CG, Stotz L, Hamza A, et al. Impact of different intraoperative CO₂ pressure levels (8 and 15 mmHg) during laparoscopic hysterectomy performed due to benign uterine pathologies on postoperative pain and arterial pCO₂ : a prospective randomised controlled clinical trial. BJOG. 2019; 126:1276–85.

6. Madsen MR, Jensen KE. Postoperative pain and nausea after laparoscopic cholecystectomy. Surg Laparosc Endosc. 1992; 2:303–5.

7. Kietpeerakool C, Rattanakanokchai S, Yantapant A, Roekyindee R, Puttasiri S, Yanaranop M, et al. Pulmonary recruitment maneuver for reducing shoulder pain after laparoscopic gynecologic surgery: a network meta-analysis of randomized controlled trials. Minim Invasive Surg. 2020; 2020:7154612.

8. García-Fernández J, Canfrán S, de Segura IA, Suarez-Sipmann F, Aguado D, Hedenstierna G. Pressure safety range of barotrauma with lung recruitment manoeuvres: a randomised experimental study in a healthy animal model. Eur J Anaesthesiol. 2013; 30:567–74.

9. Lovas A, Szakmány T. Haemodynamic effects of lung recruitment manoeuvres. BioMed Res Int. 2015; 2015:478970.

10. Cho M, Kim CJ, Hahm TS, Lee YY, Kim TJ, Lee JW, et al. Combination of a pulmonary recruitment maneuver and intraperitoneal bupivacaine for the reduction of postoperative shoulder pain in gynecologic laparoscopy: a randomized, controlled trial. Obstet Gynecol Sci. 2020; 63:187–94.

11. Lee J, Park C, Kim J, Ki Y, Cha SH, Kim JY. Effect of low-pressure pulmonary recruitment maneuver on postlaparoscopic shoulder pain: randomized controlled trial. J Minim Invasive Gynecol. 2020; 27:173–7.

12. Yilmaz G, Kiyak H, Akca A, Salihoglu Z. Low-pressure pulmonary recruitment maneuver: equal to or worse than moderate-pressure pulmonary recruitment maneuver in preventing postlaparoscopic shoulder pain? A randomized controlled trial of 72 patients. Wideochir Inne Tech Maloinwazyjne. 2020; 15:519–25.

13. Sroussi J, Elies A, Rigouzzo A, Louvet N, Mezzadri M, Fazel A, et al. Low pressure gynecological laparoscopy (7mmHg) with AirSeal® system versus a standard insufflation (15mmHg): a pilot study in 60 patients. J Gynecol Obstet Hum Reprod. 2017; 46:155–8.

14. Tan M, Law LS, Gan TJ. Optimizing pain management to facilitate enhanced recovery after surgery pathways. Can J Anaesth J Can Anesth. 2015; 62:203–18.

15. Morlion B, Schäfer M, Betteridge N, Kalso E. Non-invasive patient-controlled analgesia in the management of acute postoperative pain in the hospital setting. Curr Med Res Opin. 2018; 34:1179–86.