title: A simple clinical maneuver to reduce laparoscopy-induced shoulder pain: a randomized controlled trial.
abstract: 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).
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  www.clinicaltrials.gov, ClinicalTrials.gov, NCT00575237
  
  
  METHODS
  I.
authors.affiliation: Department of Anesthesia, Southwest Healthcare System, Murrieta, California, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Phelps
authors.forename: O Serpil
authors.initials: OS
authors.lastname: Cakmakkaya
authors.forename: Christian C
authors.initials: CC
authors.lastname: Apfel
authors.forename: Oliver C
authors.initials: OC
authors.lastname: Radke
mesh_terms: D000328:Adult; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D018475:Head-Down Tilt; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D020069:Shoulder Pain / Q000209:etiology / Q000517:prevention & control*