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.

Abstract

A b s t r a c tIntroduction: The pulmonary recruitment maneuver (PRM) has emerged as an effective way of reducing post-laparoscopic shoulder pain (PLSP). However, the optimal lower pressure level for a PRM to reduce PLSP has not yet been investigated. Aim: To compare the efficacy of the low-pressure PRM with moderate-pressure PRM in preventing PLSP. Material and methods: Seventy-two ASA I-II patients who were scheduled for gynecologic LS for non-malignant conditions were enrolled in this study. Group 1 included patients who received the PRM at a maximum pressure of 30-40 cm H 2 O in a semi-Fowler position and group 2 included patients who received the PRM at a maximum pressure of 15 cm H 2 O in a semi-Fowler position. The primary outcome of the study was the difference in PLSP between the two groups. Results: There were no significant differences in PLSP and wound pain VAS scores between patients receiving the PRM at 30 cm H 2 O and 15 cm H 2 O during postoperative pain monitoring (p < 0.05). The groups were also similar with respect to ambulation time (p = 0.215), length of hospital stay (p = 0.556) and the height of the pneumoperitoneum measured on chest X-ray (p = 0.151). provides similar efficacy as the moderate-pressure PRM (30-40 cm H 2 O) in terms of PLSP, wound pain, height of pneumoperitoneum, time of ambulation and length of hospital stay. We suggest that lower maximal inspiratory pressure of 15 cm H 2 O might be preferred to avoid the potential complications of the PRM with higher pressures.

Complications in laparoscopic and robotic-assisted surgery: definitions, classifications, incidence and risk factors - an up-to-date review.

“…PLSP usually lasts 1–3 (occasionally up to 7) days [ 120 , 121 ]. The main risk factor for developing PLSP is residual intraabdominal CO 2 ; therefore maneuvers improving its elimination at the end of surgery, such as gas suction and saline instillation before leaving the abdomen as well as the pulmonary recruitment maneuver, reduce the incidence and severity of PLSP [ 121 – 125 ].…”

Intraoperative respiratory and hemodynamic strategies for reducing nausea, vomiting, and pain after surgery: Systematic review and meta‐analysis

“…Eleven publications investigated the effect of recruitment maneuvers on pain and/or PONV 48–58 . All trials included ≤150 patients with all patients undergoing surgery in the abdominal region.…”

“…The patients were placed in the Trendelenburg position during the maneuver, except in one trial with the patients in the supine position 53 . One small trial compared recruitment maneuvers of different pressure, 15 vs. 30–40 cmH 2 O and was not considered further 56 . Additional information is reported in Tables S16–S19.…”

“…Eleven publications investigated the effect of recruitment maneuvers on pain and/or PONV. [48][49][50][51][52][53][54][55][56][57][58] All trials included ≤150 patients with all patients undergoing surgery in the abdominal region. Ten of the trials compared recruitment maneuvers consisting of 2-6 manual pulmonary inflations with pressure up to 60 cmH 2 O with no recruitment maneuvers.…”

Sodium Bicarbonate Sub-Diaphragmatic Irrigation Relieves Shoulder Pain After Total Laparoscopic Hysterectomy: A Randomized Controlled Trial

“…18,19 Therefore, evacuating residual CO2 to prevent PLSP is likely the first precaution. Varied approaches based on removing CO2 include pulmonary recruitment maneuver (PRM), [20][21][22] intraperitoneal normal saline infusion, 23 and both combined. 24,25 Furthermore, the application of body position change to facilitate gas drain is also effective to reduce PLSP.…”