Effect of Low-pressure Pulmonary Recruitment Maneuver on Postlaparoscopic Shoulder Pain: Randomized Controlled Trial

Abstract

Study objective: Postlaparoscopic shoulder pain (PLSP) is effectively reduced by a pulmonary recruitment maneuver (PRM). The goal of this study is to assess the efficacy of a PRM using maximal inspiratory pressure of 30 cm H₂O, which is lower than previously studied pressure for reducing PLSP.

Design: Randomized controlled trial.

Setting: University hospital.

Patients: Eighty-four patients who were undergoing elective gynecologic laparoscopy.

Interventions: Patients were randomly assigned to the control (n = 42) or the PRM (n = 42) group.

Measurements and main results: The primary outcome was the intensity of the shoulder pain using the visual analog scale (VAS). The VAS score of shoulder pain (median [interquartile range]) was significantly lower in the PRM group than in the control group at 24 hours (0 [0-0] vs 1.5 [0-4.0], p <.001) and 48 hours (0 [0-0] vs 1.0 [0-2.0], p <.001) after surgery. Other variables, including surgical pain score and vital signs, were similar between the 2 groups.

Conclusion: The PRM with 30 cm H₂O can be a simple method to reduce PLSP. Therefore, it would be helpful to perform the PRM with 30 cm H₂O routinely.

Keywords: Laparoscopy; Low pressure; Pulmonary recruitment maneuver; Shoulder pain.