title: The impact of a pulmonary recruitment maneuver to reduce post-laparoscopic shoulder pain: A randomized controlled trial.
abstract: OBJECTIVE
  A pulmonary recruitment maneuver (PRM) can effectively reduce post-laparoscopic shoulder pain (PLSP). However, a high-pressure PRM may cause pulmonary barotrauma. This study aimed to evaluate the efficacy and safety of a PRM using two different maximum inspiratory pressures (40 and 60cmH2O) for reducing PLSP.
  
  
  METHODS
  Patients undergoing gynecologic laparoscopy were randomly allocated to a control group (n=30), a 40 cmH2O PRM group (n=30), and a 60 cmH2O PRM group (n=30). In the control group, residual carbon dioxide was removed by passive exsufflation through the port site. In the two intervention groups, the PRM consisting of five manual pulmonary inflations was performed at the end of surgery with a maximum pressure of 40 cmH2O or 60 cmH2O, respectively. Shoulder pain and wound pain were recorded using a visual analogue scale at 24 and 48h postoperatively.
  
  
  RESULTS
  Wound pain scores at 24 and 48h post-surgery were not different between the three groups. The PLSP scores in the two intervention groups were significantly lower than that seen in the control group at 24 and 48h postoperatively (P=0.006 and P<0.001, respectively). However, there were no statistically significant differences in the PLSP scores between the two intervention groups.
  
  
  CONCLUSIONS
  A low-pressure PRM (40cmH2O) is as effective as a high-pressure PRM (60cmH2O) for removing residual gas from the peritoneal cavity. PRM using a maximal inspiratory pressure of 40cmH2O is safe and efficacious for the reduction of PLSP.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Kyoungho
authors.initials: K
authors.lastname: Ryu
authors.affiliation: Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Wonjun
authors.initials: W
authors.lastname: Choi
authors.affiliation: Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Jaegeum
authors.initials: J
authors.lastname: Shim
authors.affiliation: Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: taejong.song@gmail.com.
authors.forename: Taejong
authors.initials: T
authors.lastname: Song
mesh_terms: D000328:Adult; D001469:Barotrauma / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D002245:Carbon Dioxide / Q000009:adverse effects; D003964:Diaphragm / Q000293:injuries / Q000294:innervation; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006786:Hospitals, Urban; D006801:Humans; D007385:Intermittent Positive-Pressure Ventilation / Q000379:methods; D007431:Intraoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D010535:Laparoscopy / Q000009:adverse effects*; D008875:Middle Aged; D020258:Neurotoxicity Syndromes / Q000503:physiopathology / Q000517:prevention & control; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D053591:Referred Pain / Q000209:etiology / Q000517:prevention & control; D059348:Peripheral Nerve Injuries / Q000503:physiopathology / Q000517:prevention & control; D011027:Pneumoperitoneum / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D056910:Republic of Korea; D012782:Shoulder / Q000294:innervation; D020069:Shoulder Pain / Q000209:etiology / Q000517:prevention & control*
chemical_list: D002245:Carbon Dioxide
keywords: Barotrauma; Laparoscopy; Postlaparoscopic shoulder pain; Pulmonary recruitment maneuver