Effect of Trendelenburg positioning on post-operative shoulder pain after gynecological laparoscopy: a randomized clinical trial

Minimally invasive surgical techniques have transformed disease management paradigms; however, laparoscopy remains associated with significant post-operative morbidity. Approximately 80% of patients report severe shoulder pain within 24 h following gynecological laparoscopic procedures despite inherent advantages over open surgery. We aimed to evaluate the efficacy of post-operative Trendelenburg positioning in mitigating shoulder pain after gynecological laparoscopy. This randomized non-blinded trial enrolled 82 women (18–60 years) undergoing gynecological laparoscopy. Participants were allocated to either an intervention group (20° Trendelenburg position for 8 post-operative hours, n = 41) or control group (supine position with 0° head elevation, n = 41). Shoulder pain severity was assessed using the Numerical Rating Scale (NRS 0–10) at baseline, and at 6, 12, and 24 h post-operative intervals. Intervention group demonstrated significantly lower pain scores at all timepoints (baseline: 4.02 ± 0.28 vs. 5.21 ± 0.26; 6 h: 1.65 ± 0.22 vs. 3.56 ± 0.31; 12 h: 0.58 ± 0.17 vs. 2.34 ± 0.29; 24 h: 0.26 ± 0.22 vs. 1.48 ± 0.22; all p < 0.001). While both groups showed temporal pain reduction (p < 0.001), the intervention group exhibited significantly accelerated resolution (time × group interaction p = 0.004). Nausea/vomiting incidence was markedly lower in the intervention group (29.3% vs. 58.5%, p = 0.008). Post-operative 20° Trendelenburg positioning significantly reduces shoulder pain severity and accelerates recovery following gynecological laparoscopy. This noninvasive, zero-cost technique (easily implemented by nursing staff) represents a clinically impactful strategy to enhance post-operative recovery. The protocol of this randomized, superiority, non-blinded clinical trial on parallel groups was registered on IRCT (IRCT20250224064837N1; URL: https://irct.behdasht.gov.ir/trial/83138) on 2025/05/24.