Semi-Fowler positioning in addition to the pulmonary recruitment manoeuvre reduces shoulder pain following gynaecologic laparoscopic surgery.

Abstract

IntroductionThe semi-Fowler position, defined as a body position at 30° head-of-bed elevation, has been shown to increase intra-abdominal pressure.AimTo investigate the impact of semi-Fowler positioning in addition to the pulmonary recruitment manoeuvre (PRM) on post-laparoscopic shoulder pain.Material and methodsOne hundred and six patients (mean age: 43 ±12 years) undergoing gynaecologic laparoscopic surgery (LS) were included. The patients were divided into three groups: group 1 consisted of patients receiving PRM in the neutral position, group 2 comprised patients receiving PRM in the semi-Fowler position, and patients in the control group received neither PRM nor additional positioning. Information concerning wound and shoulder pain (post-laparoscopic shoulder pain – PLSP) at postoperative 6, 12 and 24 h was recorded using a visual analogue scale (VAS) for each patient.ResultsThe PLSP scores at postoperative 6 h (5.71 ±0.86, 5.28 ±0.84 and 6.61 ±0.91, respectively, p < 0.001), 12 h (4.41 ±0.83, 4.01 ±0.82 and 5.32 ±0.97, respectively, p < 0.001), and 24 h (3.24 ±0.78, 2.44 ±0.73 and 4.34 ±0.85, respectively, p < 0.001) were significantly different among the groups, the lowest being in those who received PRM in addition to semi-Fowler positioning.ConclusionsSemi-Fowler positioning in addition to PRM significantly reduces post-laparoscopic shoulder pain. We assume that the benefit gained using the semi-Fowler positioning is mainly derived from its potential to better evacuate the remaining abdominal gas following LS.

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].…”

“…Duration of surgery in the PRM group was a few minutes longer than in the control group. 10 of 11 prior studies indicate that PRM do not prolong surgery [ 3 , 4 , 6 , 7 , 9 , 13 , 14 , 25 – 27 ]. A reason surgical duration was slightly longer in our PRM group could be that the operating team had varying experience of the maneuvre.…”

Pulmonary recruitment maneuver reduces the intensity of post-laparoscopic shoulder pain: a systematic review and meta-analysis

“…Eleven studies compared control group (passive abdominal pression) with PRM alone. [16][17][25][26][27][28][29][30][31][32][33][34][35][36] Three studies compared abdominal pression with PRM combined with intraperitoneal saline instillation. [33,[35][36]…”

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 pulmonary recruitment maneuver (PRM) has emerged as an effective way of reducing PLSP through increasing the intraperitoneal pressure and assisting the evacuation of the remaining carbon dioxide. In a recent trial from our institute, it was shown that the PRM with 30 to 40 cm H 2 O pressure in a semi-Fowler position (30° head-of-bed elevation) leads to a significant reduction in PLSP compared to the PRM in the neutral position or compared to the passive evacuation of the abdominal carbon dioxide without the PRM [ 2 ]. However, the PRM with higher pressure carries the risk of pulmonary barotrauma complications and hemodynamic deterioration [ 3 , 4 ].…”