Low-pressure Pulmonary Recruitment Maneuver to Decrease Post-laparoscopic Shoulder Pain in Gynecologic Surgery: A Double-blind Randomized Placebo Controlled Trial

Objective: To evaluate the efficacy of minimum optimal pressure (30 and 40 cmH2 O) of pulmonary recruitment maneuver (PRM) for reducing post-laparoscopic shoulder pain (PLSP). Methods: Women who were scheduled for laparoscopic gynecologic surgery during October 2020 to June 2021 were enrolled and randomly assigned to three groups: PRM 30 cmH2 O (30-PRM) group, PRM 40 cmH2 O (40-PRM) group and control group. All participants were placed in the Trendelenburg position and compressed abdomen to eradicate gas. PLSP scores were assessed by using a visual analog scale (VAS). Results: Total of 80 women were included and randomized to 30-PRM group (N = 28), 40-PRM group (N = 26) and control group (N = 26).The PLSP scores at 12-hour after surgery in 40-PRM group were significantly lower than the control group (VAS 0 = 57.7%, VAS 1-3 = 19.2% and VAS ≥ 4 = 23.1% in 40-PRM group vs VAS 0 =19.2%, VAS 1-3 = 26.9% and VAS ≥ 4 = 53.9% in control group, P = 0.018), while no significant difference of PLSP between 30-PRM and control groups (P = 0.256). Other variables, such as PLSP at 24 and 48 hrs., post-operative surgical pain, nausea and vomiting, vital signs and residual gas in abdominal cavity at 24-hour were similar among three groups. Conclusions: PRM with pressure 40 cmH2 O significantly decreases PLSP at 12 hours. This procedure is feasible and safe. Using the PRM with pressure 40 cmH2 O may be applied at the end of laparoscopic procedure