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Tsai H, Chen Y, Ho C, et al. Maneuvers to Decrease Laparoscopy-Induced Shoulder and Upper Abdominal Pain: A Randomized Controlled Study. Arch Surg. 2011;146(12):1360–1366. doi:10.1001/archsurg.2011.597
Author Affiliations: Departments of Obstetrics and Gynecology (Drs H.-W. Tsai, Chen, Chao, and Wang) and Anesthesia (Drs Ho and Hseu), Taipei Veterans General Hospital, National Yang-Ming University, and Department of Anesthesia, Chen-Hsin General Hospital (Dr S.-K. Tsai), Taipei, Taiwan.
Objective To evaluate the effectiveness of the pulmonary recruitment maneuver (PRM) and intraperitoneal normal saline infusion (INSI) in removing postlaparoscopic carbon dioxide from the abdominal cavity to decrease laparoscopy-induced abdominal or shoulder pain after surgery.
Design, Setting, and Patients A prospective, randomized, controlled trial was conducted at Taipei Veterans General Hospital, Taipei, Taiwan, from August 1, 2009, through June 30, 2010. One hundred fifty-eight women undergoing laparoscopic surgery for benign gynecologic lesions were randomly assigned to 3 groups: the PRM group (n = 53), the INSI group (n = 54), and the control group (n = 51).
Interventions Postoperative maneuvers included PRM and INSI.
Main Outcome Measures Evaluation of pain, including abdominal pain and shoulder pain, was performed at 12, 24, and 48 hours postoperatively.
Results The frequency of postoperative shoulder pain at 24 and 48 hours was significantly decreased in the INSI group compared with that of either the PRM or control group (40.7% and 24.1% in the INSI group vs 66.0% and 50.9% in the PRM group [P = .009 and .004, respectively] or vs 72.5% and 54.9% in the control group [both P < .001]). Both methods significantly reduced the frequency of upper abdominal pain compared with the control condition (73.6% in the PRM group at 24 hours [P = .03] or 72.2% at 24 hours [P .02] and 44.4% at 48 hours [P = .01] in the INSI group vs 90.2% at 24 hours and 68.6% at 48 hours in the control group).
Conclusions Both PRM and INSI could effectively reduce pain after laparoscopic surgery, but INSI might be better for both upper abdominal and shoulder pain.
Trial Registration clinicaltrials.gov Identifier: NCT01135836
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