The impact of a pulmonary recruitment maneuver to reduce post-laparoscopic shoulder pain: A randomized controlled trial

Ryu, K.; Choi, Won-Jun; Shim, Jae-Geum; Song, Taejong

doi:10.1016/j.ejogrb.2016.11.014

Cited by 26 publications

(38 citation statements)

References 26 publications

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“…Less well studied is whether low inspiratory pressure PRM is as effective as higher pressure for reducing postlaparoscopic shoulder pain. 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.…”

Section: Discussionmentioning

confidence: 99%

“…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].…”

Section: Characteristics Of Included Studies a Broad Search Inmentioning

confidence: 99%

“…Hours. Seven studies involving 726 participants determined shoulder pain intensity at 24 hours after the operation [1,13,14,16,18,21,22]. When compared with abdominal compression, either PRM alone or PRM combined with IPS significantly reduced shoulder pain intensity with MD of VAS varying from 1.5 to 1.9. ere was no significant benefit of IPS for reducing shoulder pain intensity at 24 hours when combined with PRM.…”

Section: Intensity Of Shoulder Pain At 24mentioning

confidence: 99%

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

Kietpeerakool

Rattanakanokchai

Yantapant

et al. 2020

Minimally Invasive Surgery

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Background. Shoulder pain is a common symptom following laparoscopic surgery. This systematic review was undertaken to assess updated evidence regarding the effectiveness and complications of the pulmonary recruitment maneuver (PRM) for reducing shoulder pain after laparoscopic gynecologic surgery. Methods. A number of databases for randomized controlled trials (RCTs) investigating PRM for reducing shoulder pain were searched up to June 2019. Two authors independently selected potentially relevant RCTs, extracted data, assessed risk of bias, and compared results. Network meta-analyses were employed to simultaneously compare multiple interventions. Effect measures were presented as pooled mean difference (MD) or risk ratio (RR) with corresponding 95% confidence intervals (CI). Results. Of the 44 records that we identified as a result of the search (excluding duplicates), eleven RCTs involving 1111 participants were included. Three studies had an unclear risk of selection bias. PRM with a maximum pressure of 40 cm H2O was most likely to result in the lowest shoulder pain intensity at 24 hours (MD −1.91; 95% CI −2.06 to −1.76) while PRM with a maximum pressure of 40 cm H2O plus intraperitoneal saline (IPS) appeared to be the most efficient at 48 hours (MD −2.09; 95% CI −2.97 to −1.21). The estimated RRs for analgesia requirement, nausea/vomiting, and cardiopulmonary events were similar across the competing interventions. Conclusion. PRM with 40 cm H2O performed either alone or accompanied by IPS is a promising intervention for alleviating shoulder pain within 48 hours following gynecologic laparoscopy.

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Section: Discussionmentioning

confidence: 99%

Section: Characteristics Of Included Studies a Broad Search Inmentioning

confidence: 99%

Section: Intensity Of Shoulder Pain At 24mentioning

confidence: 99%

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

Kietpeerakool

Rattanakanokchai

Yantapant

et al. 2020

Minimally Invasive Surgery

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“…However, inflation with a maximum pressure of 60 cm H 2 O may carry a risk of pneumothorax. In fact, the literature suggests that a pulmonary recruitment maneuver with a peak pressure of 40 cm H 2 O is a safe and effective way of improving arterial oxygenation during anesthesia [34][35][36][37][38]. It is meaningful that our study showed that the pulmonary recruitment maneuver significantly reduces shoulder pain in more than triple the number of patients and using a lower pressure than that in the study of Phelps et al [21].…”

Section: Discussionmentioning

confidence: 47%

Combination of a pulmonary recruitment maneuver and intraperitoneal bupivacaine for the reduction of postoperative shoulder pain in gynecologic laparoscopy: a randomized, controlled trial

et al. 2020

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Objective To compare the efficacy of a pulmonary recruitment maneuver using lower airway pressure (30 cm H 2 O) and intraperitoneal bupivacaine, alone or in combination, for reducing shoulder pain after gynecologic laparoscopy. Methods A prospective controlled study was performed in a teaching hospital with patients who underwent elective gynecologic laparoscopic surgery. Two hundred eighty-seven patients were randomized into 1 of 4 groups: group A, placebo; group B, intraperitoneal instillation of bupivacaine; group C, CO 2 removal by a pulmonary recruitment maneuver; group D, combination of intraperitoneal bupivacaine and pulmonary recruitment maneuver. The interventions were performed at the end of surgery. Shoulder pain was recorded on a visual analog scale (VAS) at 1, 6, 12, and 24 hours postoperatively. Results The overall incidence of shoulder pain was 49.8% and the incidence tended to gradually decrease from group A to group D (59.0% in group A, 54.8% in group B, 44.4% in group C, and 41.5% in group D; P=0.026). In addition, the VAS scores gradually decreased from group A to D, although a statistically significant difference was only found at 6 hours postoperatively (P=0.03). There were no complications related to the interventions. Conclusion The combination of a pulmonary recruitment maneuver with intraperitoneal bupivacaine significantly reduced shoulder pain after gynecologic laparoscopy. Trial Registration ClinicalTrials.gov Identifier: NCT01039441.

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“…Ricard [ 25 ] reported that an alveolar recruitment maneuver of 40 cmH 2 O safely and effectively improved arterial oxygenation during anesthesia. Similarly, in a prospective study, Ryu et al [ 26 ] demonstrated that the PRM using a maximal inspiratory pressure of 40 cmH 2 O is as effective as a 60 mmH 2 O for removing CO 2 from the peritoneal cavity. Furthermore, Phelps et al [ 14 ] and Sharami et al [ 21 ] evaluated only shoulder pain.…”

Section: Discussionmentioning

confidence: 96%

Effect of the pulmonary recruitment maneuver on pain after laparoscopic gynecological oncologic surgery: a prospective randomized trial

2018

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ObjectiveTo evaluate the effectiveness of the pulmonary recruitment maneuver (PRM) at the end of the operation to decrease laparoscopy-induced abdominal or shoulder pain after gynecological oncologic surgery.MethodsIn total, 113 women undergoing laparoscopic surgery for malignant or premalignant gynecological lesions were assigned randomly to two groups: the PRM group (the patient was placed in the Trendelenburg position (30°) and the PRM, consisting of two manual pulmonary inflations to a maximum pressure of 40 cmH2O) (n=54) and the control group (n=52). Postoperative shoulder and abdominal pain was assessed 12, 24, and 48 hours later using a visual analog scale (0–10). In addition, the incidence of post-discharge nausea and vomiting was recorded until 48 hours after discharge.ResultsPostoperative shoulder pain at 12 and 24 hours was significantly less severe in the PRM group (2.2±0.5 and 2.0±0.4) than in the control group (4.0±0.5 and 3.9±0.4; both p<0.001). The PRM significantly reduced the severity of upper abdominal pain at 12 and 24 h compared with the control group (3.1±0.4 and 2.9±0.4 vs. 5.9±0.5 and 4.9±0.5; both p<0.001). The analgesic requirement during the postoperative period was similar in the two groups (control group, 78.8%; PRM group, 75.9%; p=0.719).ConclusionThe PRM effectively and safely reduced postoperative shoulder and upper abdominal pain levels in patients undergoing laparoscopic gynecological oncologic surgery. Trial registry at ClinicalTrials.gov, NCT01940042.

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The impact of a pulmonary recruitment maneuver to reduce post-laparoscopic shoulder pain: A randomized controlled trial

Cited by 26 publications

References 26 publications

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

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

Combination of a pulmonary recruitment maneuver and intraperitoneal bupivacaine for the reduction of postoperative shoulder pain in gynecologic laparoscopy: a randomized, controlled trial

Effect of the pulmonary recruitment maneuver on pain after laparoscopic gynecological oncologic surgery: a prospective randomized trial

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