The impact of a pulmonary recruitment maneuver to reduce post-laparoscopic shoulder pain: A randomized controlled trial

Abstract

Objective: A pulmonary recruitment maneuver (PRM) can effectively reduce post-laparoscopic shoulder pain (PLSP). However, a high-pressure PRM may cause pulmonary barotrauma. This study aimed to evaluate the efficacy and safety of a PRM using two different maximum inspiratory pressures (40 and 60cmH₂O) for reducing PLSP.

Study design: Patients undergoing gynecologic laparoscopy were randomly allocated to a control group (n=30), a 40 cmH₂O PRM group (n=30), and a 60 cmH₂O PRM group (n=30). In the control group, residual carbon dioxide was removed by passive exsufflation through the port site. In the two intervention groups, the PRM consisting of five manual pulmonary inflations was performed at the end of surgery with a maximum pressure of 40 cmH₂O or 60 cmH₂O, respectively. Shoulder pain and wound pain were recorded using a visual analogue scale at 24 and 48h postoperatively.

Results: Wound pain scores at 24 and 48h post-surgery were not different between the three groups. The PLSP scores in the two intervention groups were significantly lower than that seen in the control group at 24 and 48h postoperatively (P=0.006 and P<0.001, respectively). However, there were no statistically significant differences in the PLSP scores between the two intervention groups.

Conclusion: A low-pressure PRM (40cmH₂O) is as effective as a high-pressure PRM (60cmH₂O) for removing residual gas from the peritoneal cavity. PRM using a maximal inspiratory pressure of 40cmH₂O is safe and efficacious for the reduction of PLSP.

Keywords: Barotrauma; Laparoscopy; Postlaparoscopic shoulder pain; Pulmonary recruitment maneuver.