title: Maneuvers to decrease laparoscopy-induced shoulder and upper abdominal pain: a randomized controlled study.
abstract: 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.
  
  
  METHODS
  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).
  
  
  METHODS
  Postoperative maneuvers included PRM and INSI.
  
  
  METHODS
  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.
authors.affiliation: Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, National Yang-Ming University, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan.
authors.forename: Hsiao-Wen
authors.initials: HW
authors.lastname: Tsai
authors.forename: Yi-Jen
authors.initials: YJ
authors.lastname: Chen
authors.forename: Chiu-Ming
authors.initials: CM
authors.lastname: Ho
authors.forename: Shu-Shya
authors.initials: SS
authors.lastname: Hseu
authors.forename: Kuan-Chong
authors.initials: KC
authors.lastname: Chao
authors.forename: Shen-Kou
authors.initials: SK
authors.lastname: Tsai
authors.forename: Peng-Hui
authors.initials: PH
authors.lastname: Wang
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D002245:Carbon Dioxide; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D011027:Pneumoperitoneum / Q000150:complications; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects*; D011175:Positive-Pressure Respiration / Q000379:methods*; D011446:Prospective Studies; D020069:Shoulder Pain / Q000209:etiology / Q000517:prevention & control*; D012965:Sodium Chloride / Q000008:administration & dosage*
chemical_list: D002245:Carbon Dioxide; D012965:Sodium Chloride