Randomised clinical trial of the influence of pulmonary recruitment manoeuvre on reducing shoulder pain after laparoscopy

Abstract

Shoulder pain after laparoscopy is common and its probable mechanism is residual CO₂ gas after surgery. The aim of this study was to examine the effect of pulmonary recruitment manoeuvre which means pulmonary inflation with positive pressure of 40 cm H₂O to remove gas and reduction of shoulder pain after gynaecological laparoscopic surgery. A double-blind clinical trial on 146 patients for minor gynaecological laparoscopy was performed from May 2008 to February 2009. Patients were randomly assigned into two groups of control and intervention (cases). The intervention was five manual inflations of the lungs with positive pressure ventilation of 40 cmH₂O at the end of surgery, while the last one was held for 5 s. In the controls, CO₂ was removed by the traditional passive deflation of abdominal cavity. Shoulder pain intensity was assessed at 4, 12, 24 and 48 h after the surgery using a visual analogue scale (VAS).The background variables; characteristics of operation and analgesic use were recorded. Statistical significance was defined as p < 0.05. A total of 131 complete sets of data were analysed. Participants in the two groups were matched for age, parity, body mass index, type of surgery and CO₂ pressure setting. The relative frequency of shoulder pain at 4 h did not show significant differences in the two groups, but was lower in the intervention group at 12, 24, and 48 h after the surgery (p = 0.001). Pain scores in the control and intervention group were 3.6 ± 3.5 vs 1.28 ± 1.7; 3.4 ± 2.9 vs 1.19 ± 1.7; 2.6 ± 2.4 vs 0.89 ± 1.3; 1.5 ± 1.6 vs 0.46 ± 0.7, at 4, 12, 24 and 48 h after operation, respectively (p < 0.001). The controls had greater usage of analgesics 1.12 ± 5.67 compared with 0.95 + 0.31 in the cases. It was concluded that pulmonary recruitment manoeuvre seems to be a simple and safe way to reduce shoulder pain and analgesic use after laparoscopy.

Keywords:

• Laparoscopy
• pulmonary recruitment manoeuvre
• shoulder pain

Acknowledgement

The authors would like to thank Mrs M. Ahmad Soltani, S. F. Dalil Hirati and Mrs M. Shakiba for their collaboration.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.