Comparison of Intraperitoneal Normal Saline Infusion with Pulmonary Recruitment Maneuver in Reducing Shoulder and Upper Abdomen Pain Following Gynecologic Laparoscopic Procedures: A Randomized, Controlled, Triple-Blind Trial

Abstract

Objectives The current study aimed at evaluating the effect of intraperitoneal infusion of normal saline (NS) and pulmonary recruitment maneuver (PRM) on the reduction of pain in shoulder, upper abdomen, and incision site after elective laparoscopic gynecologic surgery. Methods Totally, 280 patients (mean age: 30.5 years) that underwent laparoscopic gynecologic surgery from October 2013 to August 2015 were randomly and equally allocated into four groups. Group A received intraperitoneal infusion of NS 1.5 - 2 mL/kg of body weight; group B received PRM with five manual pulmonary inflations at a maximum pressure of 60 cm H 2 O; group C simultaneously received two former interventions; and finally the control group D received routine method of gentle abdominal pressure. All patients were assessed in the first 24 hours after surgery. Results There was an unsteady pattern for pain in shoulder, upper abdomen, and incision site at different time points across the studied groups over the trial. Patients in group B showed significantly lower shoulder pain 24 hours after laparoscopic gynecologic surgery (P = 0.01), while patients in group D had significantly lower incision site pain (P < 0.001). Conclusions PRM was superior to intraperitoneal infusion of NS for reducing pain in the first 24 hours after laparoscopic gynecologic surgery.

Pulmonary Recruitment Maneuver Reduces Shoulder Pain and Nausea After Laparoscopic Cholecystectomy: A Randomized Controlled Trial

“…Incidence of wound pain differed at two occasions, 4 and 24 h after surgery, in favor of the control group. [25,26]. Two studies by Tsai et al and one study by Güngördük did not find any difference between groups regarding neither incidence nor intensity of wound pain [6,7,27].…”

Post Laparoscopy Pain Reduction Project I (POLYPREP I): Intraperitoneal Normal Saline Instillation—A Randomised Controlled Trial

“…Additionally, elastase activity is also increased in the indwelling uid, re ecting an intraperitoneal in ammatory reaction (27). However, the use of normal saline continues, especially for postoperative pain reduction during laparoscopy procedures due to its vast data on safety and e cacy (8, 7,10,11,13,29,30). Furthermore, when Hartmann's or Ringer's lactate solution was used instead of normal saline, there was no noticeable improvement in pain score (31).…”

“…In animal models, intraperitoneal normal saline increases lymphatic ow (23). In this study, we attempted to produce the pain relief effect of INSI by xing the lowest amount of normal saline to be instilled into the peritoneal cavity at 15 mL/kg body weight; the lowest dose tested previously (10,11,13).…”

“…In gynaecological surgery, this pain reduction technique has been implemented in several different studies. It was found that INSI signi cantly reduced shoulder and upper abdominal pain compared to no uid instillation (7)(8)(9)(10)(11)13). Although these studies were performed by the same researchers, the amount of uid instilled varied between 15-30 mL/kg body weight (10,11).…”

The Effect of Pneumoperitoneum-induced Hypertension During Laparoscopic Cholecystectomy Under General Anesthesia on Postoperative Pain: A Randomized Clinical Trial

“…Some physiological side effects of un-controlled postoperative pain can be problematic for the patients, and inefficient pain management in perioperative period may result in some annoying medical, social, economic, psychological, and individual complications (2)(3)(4). Appropriate pain management can reduce morbidity and mortality and hasten recovery and discharge rate, especially in the laparoscopic surgeries (5)(6)(7)(8)(9)(10).…”