Different maneuvers for reducing postlaparoscopic shoulder and abdominal pain: a randomized controlled trial

Abstract

Purpose The aim was to evaluate the effect of combination of recruitment maneuver (RM) or intraperitoneal saline infusion (IPS) to low-pressure pneumoperitoneum in reducing postlaparoscopic shoulder and abdominal pain in patients undergoing laparoscopic gynecologic surgeries. Patients and methods This prospective blinded randomized controlled study was conducted on 108 patients undergoing laparoscopic gynecologic surgery. Patients were randomly allocated to four groups: group C (control group) patients received standard pressure pneumoperitoneum, group L received low-pressure pneumoperitoneum, group LR received low-pressure pneumoperitoneum and intermittent five times RM at a pressure of 40 cmH2O, and group LS received low-pressure pneumoperitoneum and IPS (15–20 ml/kg). Primary outcome was visual analog scale score for shoulder pain and abdominal pain at 2, 6, 12, 24, 48, 72, and 96 h postoperatively. Results The visual analog scale values of shoulder pain and abdominal pain were statistically significantly higher in the control group at different timings postoperatively compared with the interventional groups. Moreover, the LR group had the lowest statistically significant values at all different timings except at 2, 48, 72, and 96 h, where it had no significant difference with the LS group regarding shoulder pain. However, regarding abdominal pain values, the LS group had the lowest statistically significant values at 72 and 96 h postoperatively. Conclusion Adding of RM or IPS to low-pressure insufflation could significantly decrease the intensity of postlaparoscopic shoulder and abdominal pain. However, RM seems to be more effective but it is a relatively short-acting maneuver, whereas IPS seems to be less effective but it has a longer lasting effect.