Effect of Pulmonary Recruitment Maneuver on Postlaparoscopic Shoulder Pain, Postoperative Pain and Outcomes in Gynecologic Laparoscopic Surgeries

Objective: Post-laparoscopic shoulder pain (PLSP) is a significant occurrence after laparoscopic surgery. This study investigated the effects of pulmonary recruitment maneuvers (PRM) on PLSP, postoperative pain, and patient outcomes in patients undergoing laparoscopic gynecologic surgery. Method: Patients who underwent laparoscopic gynecological surgery for benign reasons between April 2023 and October 2023 were retrospectively examined. The patients were divided into the PRM group (group PRM, n=45) and the control group (group C, n=46). In group PRM, five recruitment maneuvers were performed manually at the end of the operation with 40 cm H2O pressure. The PLSP visual analog scale (VAS) scores were compared with VAS scores at the 6th, 12th, and 24th postoperative hours, postoperative wound VAS scores, ambulation times, postoperative nausea and vomiting (PONV), bowel movement times, and hospital stay. Results: The study included 91 patients with a mean age of 49.4±9 years. The most commonly performed operations were total laparoscopic hysterectomy and bilateral salpingo-oophorectomy. The PLSP rate in Group PRM was significantly lower than in Group K (31.1% vs. 63%, p=0.002). In Group PRM, mean PLSP VAS scores at 6 (3.6 vs. 5.8), 12 (3.3 vs. 4.9), and 24 hours (2.8 vs. 3.9) postoperatively were significantly lower (p<0.001 for all). In Group PRM, postoperative 6th-hour wound pain scores were significantly lower (4.8 vs. 5.7, p=0.009). In Group PRM, ambulation time (6.6±0.9 vs. 7.5±1.5 hours, p=0.002) and bowel movement recovery time (14.2±4 vs. 16.4±5 hours, p=0.038) were also significantly lower. In Group PRM, the PONV rate (28.9% vs. 37%) and hospital stay (2.2±0.4 vs. 2.3±0.5 days) were lower, but no statistically significant difference was found. Conclusion: PRM, which can be easily applied at the end of benign laparoscopic gynecological surgeries, effectively reduces PLSP and early wound pain. It is also helpful in reducing postoperative ambulation time and in the return of bowel functions.