A Simple Clinical Maneuver to Reduce Laparoscopy-Induced Shoulder Pain

Abstract

I.

Techniques to reduce shoulder pain after laparoscopic surgery for benign gynaecological disease: a systematic review

“…Two studies also found a significant reduction in the severity of SP [8,16]. Two studies measured the VAS scores at rest [8,16], and the last study did not report whether they measured the VAS at rest or during cough/mobilisation [5]. The significant effect of PRM on SP severity was found 4-24 h after surgery and 12 h after discharge [16] and at 24 h postoperatively [8].. Two out of three studies reported post-operative analgesic consumption [8,16].…”

“…1). Of the included RCTs, six studies evaluated the effect of intraperitoneal local anaesthetics [10][11][12][13][14][15], three studies evaluated the effect of pulmonary recruitment manoeuvre (PRM) [5,8,16] and three studies evaluated the effect of drainage [17][18][19]. The remaining three studies have been grouped together as "other techniques" and evaluated the effect of intraperitoneal saline installation [20], minilaparoscopy [21] and gasless laparoscopy by using Laprolift® [22].…”

“…The most promising data were found in the studies evaluating the effect of PRM. PRM was associated with an overall reduction in both the incidence and the severity of SP [5,8,16]. PRM works by removing residual CO 2 from the peritoneal cavity by manually delivering pulmonary inflations with a pressure of between 40 and 60 cmH 2 0.…”

“…The results are presented in Table 2. All studies reported both the incidence and severity of SP [5,8,16]. In all studies, postoperative SP was assessed using VAS and PRM resulted in a significant reduction in the incidence of SP [5,8,16].…”

“…Although laparoscopic surgery results in improved patient satisfaction, a considerable portion of patients have complaints of post-operative shoulder pain (SP). Post-operative SP is hypothesised to be a result of pneumoperitoneum achieved by carbon dioxide insufflation which induces peritoneal stretching, irritation of the diaphragm and phrenic nerve resulting in referred pain to the shoulder [5]. The precise aetiology is not fully known.…”