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

Abstract

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 H 2 O, 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 H 2 O can be a simple method to reduce PLSP. Therefore, it would be helpful to perform the PRM with 30 cm H 2 O routinely.

Pulmonary Recruitment Maneuver for Reducing Shoulder Pain after Laparoscopic Gynecologic Surgery: A Network Meta-Analysis of Randomized Controlled Trials

“…Ryu et al [21] compared PRM that applied a maximum pressure of 40 cm H 2 O with IPS to PRM at a pressure of 60 cm H 2 O with IPS and noted no significant differences in the intensity of shoulder pain at 24 and 48 hours between the two comparison groups. Interestingly, Lee et al [17] compared PRM at a maximum pressure of 30 cm H 2 O to abdominal compression and observed a significant reduction of shoulder pain score at 24 and 48 hours among participants assigned to treatment by low-pressure PRM. Numerical data regarding the intensity and incidence of shoulder pain measured in a study of Lee et al [17], however, could not be meta-analyzed in the present review.…”

“…Interestingly, Lee et al [17] compared PRM at a maximum pressure of 30 cm H 2 O to abdominal compression and observed a significant reduction of shoulder pain score at 24 and 48 hours among participants assigned to treatment by low-pressure PRM. Numerical data regarding the intensity and incidence of shoulder pain measured in a study of Lee et al [17], however, could not be meta-analyzed in the present review. Based on the present network meta-analysis, in which only comparison of PRM with pressures of 40 cm H 2 O to 60 cm H 2 O was available to assess, the low-pressure PRM was as effective as a high-pressure PRM (Table 1).…”

“…Five included studies compared PRM with maximum inspiratory pressure (varying from 30 to 60 cm H 2 O) to abdominal compression [13][14][15][16][17]. A comparison of four included studies was a combination of PRM and intraperitoneal saline (IPS) versus abdominal compression [1,[18][19][20].…”

“…Only the results of comparison between PRM and abdominal compression were included [22]. Ten studies were conducted in participants with benign gynecologic conditions [1,[13][14][15][17][18][19][20][21][22]. Only one study assessed the effect of PRM following laparoscopic surgery for gynecologic cancer [16].…”

Low-pressure pulmonary recruitment maneuver: equal to or worse than moderate-pressure pulmonary recruitment maneuver in preventing postlaparoscopic shoulder pain? A randomized controlled trial of 72 patients.

“…The combination of PRM with Trendelenburg positioning was shown to reduce the severity of PLSP compared to controls receiving conventional care in women undergoing laparoscopic surgery for malignant or premalignant gynecological lesions [17]. Neverthe- [19]. Through the significant difference between the PRM group and the controls, the authors reached a conclusion that performing the PRM with 30 cm H 2 O was beneficial in reducing PLSP.…”