A pulmonary recruitment maneuver at the end of surgery reduced shoulder pain as well as
nausea and vomiting after laparoscopic surgery.
With IRB approval and informed consent, 100 female ASA 1 and 2 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 (intervention group; power analysis yielded 45 patients necessary per group).
In the control group, CO2 was removed by passive deflation of the abdominal cavity through
the holes of the trocar. In the intervention group, CO2 was removed by means of
Trendelenburg position (> 30 degrees) with 5 manual pulmonary recruitment maneuvers.
Postoperative shoulder pain was assessed prior to discharge and 12, 24, 36 and 48 hours
later using a visual analog scale (VAS). In addition, positional characteristics of the
shoulder pain and incidence of postdischarge nausea and vomiting (PDNV) were recorded 48
hours after surgery.
- age 15-65
- ASA I-II
- scheduled for outpatient gynaecological procedure
- previous laparatomy
- patients requiring hospitalisation
- procedure required conversion to laparatomy
- 48h follow-up no feasible
Paul Phelps, MD
Department of Anesthesia, Southwest Healthcare System, Murrieta, California