Effect of Pulmonary Recruitment Maneuver After Laparoscopic Cholecystectomy   to Reduce Shoulder Tip Pain

Objective: To compare the effectiveness of pulmonary recruitment maneuver (PRM) and passive release of pneumoperitoneum in terms of post-operative shoulder tip pain at 4, 8, 12, 24 and 48 hours in patients undergoing laparoscopic cholecystectomy (LC). Study Design: Quasi-experimental study. Place and Duration of Study: Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan from Oct 2021 to Sep 2022. Methodology: For this comparative study, all patients who underwent elective LC were included using convenient sampling. The patients divided into two equal groups by lottery method on the day of surgery. One group received PRM and the other group had passive release of pneumoperitoneum at the end of surgery. Data was recorded in terms of shoulder tip pain using visual analogue scale (VAS) at 4, 8, 12, 24 and 48 hours of surgery, keeping pneumoperitoneum of 15mmHg as fixed variable. SPSS version 25 was used for statistical analysis. Results: A total of 90 patients were included. There were 33 males (36.7%) and 57(63.3%) females with mean age of 47.49±11.57 years (range from 21 to 75 years). The presence of shoulder tip pain was 67.3% in passive release group and 46.5% in PRM group. The VAS score in PRM group was statistically significant (p=0.000) at 4, 8, 12, 24 and 48 hours after LC. Conclusion: The PRM reduces shoulder pain in patients after LC and is a better management plan as compared to the passive release of pneumoperitoneum.