Simple Clinical Maneuver for Reducing Shoulder Pain Following Gynecologic Laparoscopic Surgery at Maharat Nakhonratchasima Hospital: A Randomized Controlled Trial

Abstract

Objective: To assess the efficacy of simple clinical maneuver to reduce shoulder pain after gynecologic laparoscopic surgery. Study design: Randomized controlled trial. Method: One hundred and four patients who were scheduled for elective gynecologic laparoscopic surgery were randomly allocated to either the current standard as a control group or to additional efforts to remove residual CO 2 at the end of surgery groups. For 54 patients in control group, CO 2 was removed by passive deflation of the abdominal cavity through the cannula. While in 50 patients in the intervention group, CO 2 was removed by means of Trendelenbrerg position (30 degrees) and a pulmonary recruitment maneuver consisting of 5 manual inflations of lung . Postoperative shoulder pain was recorded on a verbal rating scale (VRS 1-6) at 24, 48 hours after operation. Result: There are no significant differences in age, time of surgery, type of surgery, body mass index between 2 groups  except for the postoperative hospital stay (mean,SD)  which are 2.5 + 0.57 days in the control group compared to 2.1 + 0.47 days in the intervention group (p < 0.001). Postoperative shoulder pain (VRS 2-6) in first 48 hrs was evaluated. The significant pain is found in11 in 50 patients (22%) in the intervention group compared with34 in 54 patients (63%) in the control group (p < 0.001). Conclusion: This simple clinical maneuver can reduce the number of patients complaining of shoulder pain after Gynecologic laparoscopic surgery with statistical significance.