Shoulder pain is a frequent symptom after laparoscopic surgery that is often considered to be more severe than the surgical pain itself. It is assumed that the main trigger is remaining carbondioxide that leads to irritation under the diaphragm. However, we have been able to demonstrate that shoulder pain may be reduced with a simple clinical technique consisting of 5 pulmonary recruitment maneuvers in Trendelenburg position after the deflation of the capnoperitoneum.

Objective

To estimate the efficacy of a simple clinical maneuver that facilitates removal of residual abdominal carbon dioxide (CO₂) after laparoscopic surgery to reduce shoulder pain.

Methods

A total of 116 female outpatients who were scheduled for elective gynecologic laparoscopic surgery were randomly allocated to either the current standard (control group) or to additional efforts to remove residual CO2 at the end of surgery. In the control group, CO2 was removed by passive deflation of the abdominal cavity through the cannula. In the intervention group, CO2 was removed by means of Trendelenburg position (30 degrees) and a pulmonary recruitment maneuver consisting of five manual inflations of the lung. Postoperative shoulder pain was assessed before discharge and 12, 24, 36, and 48 hours later using a visual analog scale (VAS, 0-100). In addition, positional characteristics of the shoulder pain and incidence of postdischarge nausea and vomiting were recorded until 48 hours after discharge.

Results

Pain scores in the control and intervention groups were 30.3+/-4.5 compared with 15.6+/-3.0, 25.7+/-4.7 compared with 10.8+/-2.4, and 21.7+/-4.3 compared with 9.1+/-2.5 at 12, 24 and 36 hours after discharge, respectively (all P<.05). The intervention reduced positional pain from 63% to 31% (P<.05) and the incidence of postoperative nausea and vomiting from 56.5% to 20.4% (P<.001).

Conclusion

This simple clinical maneuver at the end of surgery reduced shoulder pain as well as postoperative nausea and vomiting after laparoscopic surgery by more than half.

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