Postlaparoscopic Shoulder Pain Research Articles

Low-pressure Pulmonary Recruitment Maneuver to Decrease Post-laparoscopic Shoulder Pain in Gynecologic Surgery: A Double-blind Randomized Placebo Controlled Trial

Objective: To evaluate the efficacy of minimum optimal pressure (30 and 40 cmH2 O) of pulmonary recruitment maneuver (PRM) for reducing post-laparoscopic shoulder pain (PLSP). Methods: Women who were scheduled for laparoscopic gynecologic surgery during October 2020 to June 2021 were enrolled and randomly assigned to three groups: PRM 30 cmH2 O (30-PRM) group, PRM 40 cmH2 O (40-PRM) group and control group. All participants were placed in the Trendelenburg position and compressed abdomen to eradicate gas. PLSP scores were assessed by using a visual analog scale (VAS). Results: Total of 80 women were included and randomized to 30-PRM group (N = 28), 40-PRM group (N = 26) and control group (N = 26).The PLSP scores at 12-hour after surgery in 40-PRM group were significantly lower than the control group (VAS 0 = 57.7%, VAS 1-3 = 19.2% and VAS ≥ 4 = 23.1% in 40-PRM group vs VAS 0 =19.2%, VAS 1-3 = 26.9% and VAS ≥ 4 = 53.9% in control group, P = 0.018), while no significant difference of PLSP between 30-PRM and control groups (P = 0.256). Other variables, such as PLSP at 24 and 48 hrs., post-operative surgical pain, nausea and vomiting, vital signs and residual gas in abdominal cavity at 24-hour were similar among three groups. Conclusions: PRM with pressure 40 cmH2 O significantly decreases PLSP at 12 hours. This procedure is feasible and safe. Using the PRM with pressure 40 cmH2 O may be applied at the end of laparoscopic procedure

Effectiveness of Different Noninvasive Physiotherapy in Relieving Postlaparoscopic Shoulder pain: A Protocol for Systematic Review and Network Meta-Analysis.

Shoulder pain is one of the most common symptoms after laparoscopic surgery, which seriously affects people's health and quality of life. Many clinical studies have shown that noninvasive physiotherapy is the most beneficial treatment for patients, but the best approach for various noninvasive physiotherapy is unclear. The purpose of this study protocol is to compare the effectiveness of different noninvasive physiotherapy in relieving postlaparoscopic shoulder pain (PLSP). We will search ten electronic databases including PubMed, Web of Science, Medline, Scopus, CINAHL, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), CNKI, WanFang Data and VIP databases from their inception to November 2023. We will select randomized controlled trials (RCTs) to evaluate the effectiveness of noninvasive physiotherapy on PLSP. Our primary outcome will be to measure the intensity of shoulder pain at 24 and 48 hours after the end of the noninvasive intervention in the included study. Secondary outcomes include incidence of shoulder pain at 24 and 48 hours, postoperative nausea / vomiting and incidence of other complications after noninvasive intervention. Then, standard network meta-analysis will be conducted using Review Manager 5.4 and STATA 18. Our systematic review and network meta-analysis will identify the best noninvasive physiotherapy for PLSP patients. This systematic review will address the existing knowledge gap regarding best practice for relieving PLSP with noninvasive physiotherapy. The results of this network meta-analysis will help medical staff and patients choose the best method to relieve the PLSP. Furthermore, we hope that the results of this study will provide evidence-based for the improvement of guidelines and facilitate the decision sharing process. PROSPERO CRD42023481829.

Additional low-pressure pulmonary recruitment for reducing post-laparoscopic shoulder pain in gynecologic laparoscopy: a randomized controlled trial.

To evaluate the effectiveness of additional low-pressure pulmonary recruitment in reducing postoperative shoulder pain. A double-blind randomized controlled trial was conducted at Srinagarind Hospital between May 2021 and October 2021. Forty patients who underwent laparoscopic gynecologic surgery were randomized into either an intervention group that received additional low-pressure pulmonary recruitment (30 cmH2O) (n=20) or a control group (n=20). Shoulder pain was evaluated using a numerical rating scale from 0 to 10, 24, and 48 hours after the operation. The mean±standard deviation of shoulder pain at 24 hours after the operation of both the intervention and control groups were 2.10±2.27 and 1.45±1.73 points, respectively. The shoulder pain at 48 hours after the operation of the intervention and control groups were 1.15±1.46 and 0.85±1.73 points, respectively. There were no statistical differences in the mean difference between the two groups at 24 and 48 hours after operation (P=0.49; 95% confidence interval [CI], -0.61 to 1.91 and P=1.00; 95% CI, -0.96 to 1.56, respectively). No statistically significant differences were observed in additional analgesic medications used in either group, such as intravenous morphine or oral acetaminophen. Additional low-pressure pulmonary recruitment to reduce shoulder pain after laparoscopic surgery for benign gynecologic diseases did not show a significant benefit compared to the control group, especially when administering postoperative around-the-clock analgesia.

Comparing the effect of transcutaneous electrical nerve stimulation and massage therapy on post laparoscopic shoulder pain: a randomized clinical trial

BackgroundShoulder pain is a common clinical problem after laparoscopic surgeries. The use of non-pharmacological massage and transcutaneous electrical nerve stimulation (TENS) as an adjunct to routine treatment is increasing to provide optimal pain relief. Therefore, we aimed to determine the effect of TENS and massage therapy on post laparoscopic shoulder pain (PLSP).MethodsThis study was conducted on 138 patients who underwent laparoscopic cholecystectomy. Patients were randomly divided into three groups: massage plus conventional pharmacological treatment (n = 46), TENS plus conventional pharmacological treatment (n = 46), and conventional pharmacological treatment (n = 46). Massage and TENS were performed three consecutive times after the patients regained consciousness in the inpatient wards. The intensity of Shoulder pain was evaluated using a visual analog scale before and 20 min after each treatment.ResultsBoth massage therapy and TENS led to a significant reduction in the intensity of PLPS compared to the control group in all three measured times (p < 0.001). However, no significant difference was observed between TENS and massage at any of the three-time points.ConclusionsThis study’s findings demonstrated that massage and TENS techniques could reduce PLSP.Trial registrationRegistered in the Iranian registry of clinical trials (www.irct.ir) in 05/02/2022 with the following code: IRCT20200206046395N1.

A Randomized Comparison between Classical Landmark-based and Ultrasound-guided Right Superficial Cervical Plexus Block in Attenuating Postlaparoscopic Shoulder Pain under Subarachnoid Anesthesia

ABSTRACT Background: Postlaparoscopic shoulder pain is believed to be due to phrenic nerve involvement, with an incidence of 35%–80%. Classical landmark-based right superficial cervical plexus block (SCPB) has been utilized to alleviate postlaparoscopic shoulder pain. However, there is no possibility of phrenic nerve blockade with subcutaneously deposited injectate in landmark-based SCPB. Therefore, we hypothesized that the local anesthetic injectate in the sternocleidomastoid-scalene intermuscular fascial plane under ultrasound guidance is paramount in achieving phrenic nerve blockade. The main objective was to evaluate the effect of ultrasound-guided right SCPB in decreasing postlaparoscopic shoulder pain compared to conventional landmark-guided SCPB. Methods: In this prospective randomized trial, 79 adult patients reported for laparoscopic surgeries under spinal anesthesia were randomly divided into groups; A and B. Group A patients received intermediate approach to SCPB with 10 ml of 0.5% bupivacaine under ultrasound guidance. Group B patients received SCPB using a classical landmark-based approach. The incidence of intraoperative and postoperative shoulder pain and other adverse effects were noted. Results: Intraoperative shoulder pain was significantly less in Group A than in Group B (5% vs. 43.5%, P &lt; 0.001). The postoperative shoulder pain was also significantly reduced in Group A than in Group B (5% vs. 28.2%, P = 0.013). There were no instances of major adverse effects. Conclusion: We conclude that the ultrasound-guided injectate in the sternocleidomastoid-scalene intermuscular space deeper to investing layer but superficial to the prevertebral layer of the deep cervical fascia is central to providing superior shoulder pain relief in patients undergoing laparoscopic surgery under spinal anesthesia than the classical landmark-based SCPB.

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

BackgroundPost-laparoscopic shoulder pain (PLSP) is a common complication following laparoscopic surgeries. This meta-analysis aimed to investigate whether pulmonary recruitment maneuver (PRM) was beneficial to alleviated shoulder pain after laparoscopic procedures.MethodsWe reviewed existing literature in the electronic database from the date of inception to January 31, 2022. The relevant RCTs were independently selected by two authors, after which data extraction, assessment of the risk of bias, and comparison of results.ResultsThis meta-analysis included 14 studies involving 1504 patients, among which 607 patients were offered pulmonary recruitment maneuver (PRM) alone or in combination with intraperitoneal saline instillation (IPSI), while 573 patients were treated with passive abdominal compression. The administration of PRM significantly decreased the post-laparoscopic shoulder pain score at 12 h (MD (95%CI) − 1.12(–1.57, − 0.66), n = 801, P < 0.001, I2 = 88%); 24 h (MD (95%CI) − 1.45(–1.74, − 1.16), n = 1180, P < 0.001, I2 = 78%) and at 48 h (MD (95%CI) − 0.97(–1.57, − 0.36), n = 780, P < 0.001, I2 = 85%). We observed high heterogeneity in the study and analyzed the sensitivity but failed to identify the cause of the heterogeneity, which may have resulted from the different methodologies and clinical factors in the included studies.ConclusionThis systematic review and meta-analysis indicate that PRM can reduce the intensity of PLSP. More studies may be needed to explore the usefulness of PRM in more laparoscopic operations besides gynecological surgeries and determine the optimal pressure of PRM or its appropriate combination with other measures. The results of this meta-analysis should be interpreted with caution owing to the high heterogeneity between the analyzed studies.

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

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.

Use of intraoperative mild hyperventilation to decrease the incidence of postoperative shoulder pain after laparoscopic gastric sleeve surgery: A prospective randomised controlled study.

Background and Aims:Post-laparoscopic shoulder pain (PLSP) is a common problem. It is a referred type of pain resulting from irritation of phrenic nerve endings. Multiple manoeuvres were used to decrease its incidence with varying success rates. In this study, we tested the use of mild intraoperative hyperventilation to reduce PLSP in patients undergoing laparoscopic sleeve gastrectomy surgery (LSG).Methods:Consenting American Society of Anesthesiologists-I and II patients undergoing LSG under general anaesthesia were randomly assigned to two groups. Group A (53 patients) received intraoperative mild hyperventilation with target end-tidal carbon dioxide (ETCO2) of 30–32 mmHg. Group B (51 patients) received conventional ventilation (ETCO2 of 35–40 mmHg). Incidence and severity of PLSP, cumulative analgesic requirements and incidence of nausea and vomiting were recorded at 12 and 24 hours postoperatively and then followed up after discharge over the phone at 48 hours, 1 week, 1 month and 3 months. Statistical significance of differences between the two groups was defined at P < 0.05.Results:Incidence of PLSP was comparable between the two groups in the first 24 hours. The intervention group had a significantly lower incidence of PLSP throughout the remaining assessment points (56.6% vs. 80.4%, 30.2% vs. 78.4%, 15.1% vs. 70.6%, 3.8% vs. 35.3% at 36 hours, 48 hours, 1 week and 1 month, respectively, P < 0.05). The average PLSP pain score was significantly lower in the mild hyperventilation group at all assessment time points. Nausea and vomiting were non-significantly lower in the mild hyperventilation group.Conclusion:Mild intraoperative hyperventilation could be beneficial in reducing the incidence and severity of PLSP after LSG surgery.

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

To determine whether sub-diaphragmatic irrigation with sodium bicarbonate would relieve post-laparoscopic shoulder pain (PLSP) after total laparoscopic hysterectomy. Randomized double-blinded trial. Teaching hospital. Seventy patients undergoing total laparoscopic hysterectomy (TLH) for benign indications. We randomly allocated patients to intervention or control groups where sodium bicarbonate containing flushing liquid or normal saline was irrigated sub-diaphragm before sewing. The primary outcome was PLSP following surgery measured by a numerical rating scale (NRS) (0 = no pain; 10 = worst pain imaginable). Secondary outcomes were abdominal incisional and visceral pain, analgesic use, and sodium bicarbonate related side effects. The incidence of PLSP in intervention group was significantly lower than that in control group (P < 0.05). Contrarily, incisional and visceral pain was similar in both groups (P = 0.1). The consumption of rescue analgesics in the intervention group was lower than that in the control group. Side effects were comparable in both study groups. Sub-diaphragmatic irrigation with sodium bicarbonate could effectively reduce shoulder pain, but not abdominal incisional and visceral pain, in patients undergoing TLH without an increase in side effects. Clinical trial registry number: http://www.chictr.org.cn/ (ChiCTR2100041765). http://www.chictr.org.cn/showproj.aspx?proj=66721 Link to clinical trial page and data repository: http://www.medresman.org.cn/pub/cn/proj/projectshshow.aspx?proj=2992.

Shoulder pain after natural orifice transluminal endoscopic surgery decreased with abdominal compression and pulmonary recruitment maneuver: A retrospective study

ObjectiveThe study aimed to assess the efficacy of abdominal compression and pulmonary recruitment maneuver (CPRM) after transvaginal natural orifice transluminal endoscopic surgery (vNOTES) to alleviate post-laparoscopic shoulder pain (PLSP). Materials and methodsIn this retrospective cross-sectional study conducted in a tertiary referral medical center, women who underwent vNOTES between January 2018 and May 2019 were classified into control group and CPRM group with CO2 force expelled. Data on the demographic characteristics, indications for surgery, and surgical history were collected. Postoperative pain was assessed 24 and 48 h postoperatively using the visual analog scale (VAS, 0–10). Chest radiography was used to determine the residual air volume 24 h after surgery. ResultsOf 10 patients, 6 and 4 underwent vNOTES adnexal surgeries and vNOTES hysterectomy, respectively. The median volumes of residual pneumoperitoneum were 9.02 mL and 28.11 mL in the CPRM and control groups, respectively (p = 0.001). The intensity of PLSP in the CPRM and control groups were 0 ± 0 vs. 3.4 ± 3.4 and 0.4 ± 0.8 vs. 2.2 ± 2.2 24 and 48 h after surgery, respectively (p = 0.005 for 24 h and p = 0.04 for 48 h). ConclusionCPRM might facilitate decrease in residual gas volume and PLSP after vNOTES. CPRM might be considered using in vNOTES to decrease PLSP.

The risk of shoulder pain after laparoscopic surgery for infertility is higher in thin patients

Postlaparoscopic shoulder pain (PLSP) is a common clinical problem that needs to be addressed by medical professionals who are currently perform laparoscopic surgeries. The purpose of this study was to determine the perioperative clinical factors and demographic characteristics associated with PLSP. A prospective observational study was performed with 442 inpatients undergoing laparoscopic surgery for infertility. The pain visual analogue scale was used as the measuring instrument. To identify the predictors of PLSP, we performed multivariate conditional logistic regression. PLSP was correlated with body mass index (BMI, odds ratio = 0.815). The incidence of shoulder pain and more severe shoulder pain in patients with a lower BMI was significantly higher than it was in patients with a higher BMI, and BMI was significantly negatively correlated with PLSP. Most of the patients (95%) began to experience shoulder pain on the first postoperative day, and it rarely occurred on the day of surgery. Patients with lower BMI presented a higher risk of reporting shoulder pain on the first postoperative day. We should identify high-risk patients in advance and make specific treatment plans according to the characteristics of their symptoms.

To drain or not to drain: the association between residual intraperitoneal gas and post-laparoscopic shoulder pain for laparoscopic cholecystectomy

Residual intra-peritoneal gas may be associated with post-laparoscopic shoulder pain (PLSP), which is a frequently and disturbance compliant after surgery. Herein, we aimed to examine whether expiring residual gas via a surgical drain reduces the frequency and intensity of PLSP in the first day after laparoscopic cholecystectomy. 448 participants were enrolled in this prospective cohort study. The incidence and severity of PLSP after surgery were recorded. Of these, the cumulative incidence of PLSP in the drain group was lower particularly at the 12th postoperative hour (18.3% vs. 27.6%; P = 0.022), 24th postoperative hour (28.8% vs. 38.1%; P = 0.039), and throughout the first postoperative day (P = 0.035). The drain group had less severe PLSP (crude Odds ratio, 0.66; P = .036). After adjustment using inverse probability of treatment weighting, the drain group also had a significant lower PLSP incidence (adjusted hazard ratio = 0.61, P < 0.001), and less severe PLSP (adjusted odds ratio = 0.56, P < 0.001). In conclusion, the maneuver about passive force to expel residual gas, surgical drain use, contributes to reduce the incidence and severity of PLSP, suggesting that to minimize residual gas at the end of surgery is useful to attenuate PLSP.

Effects of delayed suprapubic port removal on post-laparoscopic shoulder pain: a randomized controlled trial

BackgroundOne of the major drawbacks of gynecologic laparoscopy is post-laparoscopic shoulder pain (PLSP) that is believed to result from intra-abdominal CO2 retention leading to peritoneal and diaphragmatic stretching and causing referred pain in C4 dermatome. Several interventions have been applied to prevent and reduce its incidence and severity, with contradictory results. Only pulmonary recruitment maneuver, extended assisted ventilation, and active intra-abdominal gas aspiration have been mentioned to be effective interventions for CO2 evacuation. However, in our experience, an alternative technique of delayed suprapubic port removal (DSPR) was found to be an effective method in CO2 expulsion. Therefore, we conducted this randomized trial to determine the effectiveness of the DSPR technique in reducing the incidence and severity of PLSP. The trial was conducted at a single, tertiary hospital between May 2015 and May 2016. Having complied with the criteria, 220 patients scheduled for elective gynecological laparoscopy were randomly allocated into 2 groups after giving informed consent. Laparoscopic procedures were performed through 10-mm umbilical port and at least 2 ancillary, including suprapubic, ports. In conventional group, ancillary ports were removed at the end of surgery leaving only opened umbilical cannula for pneumoperitoneum deflation. Abdominal compression from periphery towards umbilicus was performed to further expel CO2 before removing the umbilical cannula. In DSPR group, both umbilical and suprapubic cannulas were retained. Two-step abdominal compression was undertaken, primarily towards umbilicus and secondarily towards pelvic cavity, before sequentially removing the umbilical and the suprapubic cannulas. Postoperatively, each patient was asked to rate PLSP level on 100-mm VAS during 0–6, 6–12, 12–24, and 24–48 h, respectively. Statistical analysis was performed to determine both incidence and severity of PLSP during 24- and 48-h post-laparoscopy.ResultsPatients in DSPR group demonstrated significantly lower incidence of PLSP within 24 h (43.8% vs 59.0%; p = 0.027) and 48 h (43.8% vs 60.0%; p = 0.019), and expressed apparently lower pain scores (0 (0–0) vs 0 (0–8); p = 0.020) during 24–48 h post-surgery.ConclusionDSPR is an effective CO2 expulsion technique, resulting in significant reduction of both incidence and severity of PLSP within 24–48 h post-laparoscopy.Trial registrationThai Clinical Trials Registry, TCTR20160208003. Registered 8 February 2016 — retrospectively registered; http://www.thaiclinicaltrials.org/

Time Characteristics of Shoulder Pain after Laparoscopic Surgery.

Objective:To explore the time characteristics of shoulder pain after laparoscopic gynecological operation.Methods:We conducted prospective clinical observations and literature review. We studied 442 cases of laparoscopic gynecological surgery. We used a visual analogue scale to evaluate the pain of patients at different time points after operation. We searched the English literature of shoulder pain after gynecological laparoscopic surgery. The observation time points of these studies included 12–24 hours or the first day after surgery, and at least one time point before this time point.Results:The total incidence of shoulder pain was 68%. More than 90% of patients begin to feel shoulder pain on the first day after surgery, not on the day of surgery. 26 articles observed the severity of postlaparoscopic shoulder pain (PLSP) at different time points, of which 17 articles found that the intensity of the shoulder pain peaked at 12–24 hours or the first day after operation.Discussion:The occurrence of PLSP presents obvious time characteristics. The incidence and severity of PLSP peaked on the first day or 12–24 hours after operation. To prevent and treat PLSP better, clinicians should make a more in-depth study according to the time characteristics of PLSP.

Effect of Utilizing a Drain on Shoulder Pain in Laparoscopic Cholecystectomy. A Randomized Clinical Trial

Post-laparoscopic shoulder pain is still one of the most important complications of laparoscopic cholecystectomy. Placing a drain after laparoscopic cholecystectomy is controversial among surgeons. It is believed that shoulder pain after laparoscopic cholecystectomy is associated with insufflation of high-pressure CO2 and accumulation of residual gas in subhepatic area. Here, a randomized clinical trial was designed to evaluate the role of a routine drain on shoulder pain after laparoscopic cholecystectomy. One hundred and twenty candidates for laparoscopic cholecystectomy were enrolled in this randomized clinical trial. Among all, 50 patients were randomized to have drain in subhepatic space (group A) and 50 patients did not have it. An investigation was performed by visual scale according to having shoulder pain, abdominal pain, nausea, and vomiting during 6, 12, 24, and 48 h after operation in both groups. Abdominal pressure and anesthetic recovery medications were the same for both groups. Overall, the tip shoulder pain in (group A) was lower than patients in (group B). The mean range of shoulder pain scores after 6, 12, 24, and 48 h in group A is significantly lower than that in group B (p < 0.001). The scores for post-operation abdominal pain in groups A and B had no significant difference (p = 0.13). Moreover, no significant difference was found between shoulder pain in two groups but increasing one unit of BMI decreased vomiting to 34%. By the way, the correlation between BMI and vomiting was statistically significant. It seems that draining after laparoscopic cholecystectomy leads to less postoperative shoulder pain.

The Use of Massage Therapy as a Nonpharmacological Approach to Relieve Postlaparoscopic Shoulder Pain: a Pediatric Case Report

Postlaparoscopic shoulder pain (PLSP) has been well documented to effect patients following an abdominal or thoracic laparoscopic surgery. PLSP is characterized by referred pain that can occur both unilaterally or bilaterally, and is typically caused by phrenic nerve irritation. Current literature has focused on pharmacological treatment; however, there is limited evidence for the use of nonpharmacological management of PLSP in the pediatric population. This retrospective case report study explores the use of a single-session massage therapy treatment for a 17-year-old patient with PLSP following laparoscopic abdominal surgery. Therapy intervention included a 25 min Swedish massage involving the effected shoulder with an emphasis on passive touch to the shoulder and at the level of the diaphragm. Pain was assessed using the Visual Analog Scale (VAS) pre- and postintervention. Following therapy the patient reported 0/10 pain. This case report provides evidence for the use of massage therapy treatment as a noninvasive, nonpharmacological approach to reducing or eliminating PLSP in a pediatric patient.

Analysis of risk factors of postlaparoscopic shoulder pain.

Postlaparoscopic shoulder pain (SP), mainly caused by pneumoperitoneum with CO2 , sometimes suffers patients. This study was aimed to analyze the backgrounds of SP after gynecologic laparoscopy to clarify the risk of SP. We analyzed answers of questionnaire about the degree of SP from 696 patients undergoing gynecologic laparoscopic surgery since 2014-2018. The questionnaire asks the degree of SP with numeric rating scale from 0 to 10, before and 3 days after operation. We defined cases in which postoperative score elevated more than three compared to preoperative score as SP(+). Analyzed backgrounds were age, parity, body mass index, operative method, operative duration and amount of hemorrhage. Statistics was performed by Fisher exact analysis as univariate analysis, and with logistic regression as multivariate analysis. All laparoscopic surgeries were performed under 10-12 mmHg in pressure of pneumoperitoneum with CO2 . Univariate analysis revealed categories 'less than 50 years old', and 'over 2 h' and 'over 3 h' in operative duration resulted significant high rate of SP(+). For these three factors, multivariate analysis resulted that "less than 50 years old' and 'over 3 h in operative duration' were significantly high. This study suggests that 'less than 50 years' old and 'over 3 h in operative duration' were risk factors of postlaparoscopic SP. To protect from SP after laparoscopy, some countermeasures should be necessary especially for these patients.

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.

IntroductionThe 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.AimTo compare the efficacy of the low-pressure PRM with moderate-pressure PRM in preventing PLSP.Material and methodsSeventy-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 H2O in a semi-Fowler position and group 2 included patients who received the PRM at a maximum pressure of 15 cm H2O in a semi-Fowler position. The primary outcome of the study was the difference in PLSP between the two groups.ResultsThere were no significant differences in PLSP and wound pain VAS scores between patients receiving the PRM at 30 cm H2O and 15 cm H2O 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).ConclusionsThe low-pressure PRM (15 cm H2O pressure) provides similar efficacy as the moderate-pressure PRM (30–40 cm H2O) 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 H2O might be preferred to avoid the potential complications of the PRM with higher pressures.

The efficacy of vitamin C on postlaparoscopic shoulder pain: a double-blind randomized controlled trial

The efficacy of vitamin C on postlaparoscopic shoulder pain: a double-blind randomized controlled trial

Effect of Low-pressure Pulmonary Recruitment Maneuver on Postlaparoscopic Shoulder Pain: Randomized Controlled Trial

Study ObjectivePostlaparoscopic shoulder pain (PLSP) is effectively reduced by a pulmonary recruitment maneuver (PRM). The goal of this study is to assess the efficacy of a PRM using maximal inspiratory pressure of 30 cm H2O, which is lower than previously studied pressure for reducing PLSP. DesignRandomized controlled trial. SettingUniversity hospital. PatientsEighty-four patients who were undergoing elective gynecologic laparoscopy. InterventionsPatients were randomly assigned to the control (n = 42) or the PRM (n = 42) group. Measurements and Main ResultsThe primary outcome was the intensity of the shoulder pain using the visual analog scale (VAS). The VAS score of shoulder pain (median [interquartile range]) was significantly lower in the PRM group than in the control group at 24 hours (0 [0–0] vs 1.5 [0–4.0], p <.001) and 48 hours (0 [0–0] vs 1.0 [0–2.0], p <.001) after surgery. Other variables, including surgical pain score and vital signs, were similar between the 2 groups. ConclusionThe PRM with 30 cm H2O can be a simple method to reduce PLSP. Therefore, it would be helpful to perform the PRM with 30 cm H2O routinely.