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Prevention of postlaparoscopic shoulder and upper abdominal pain: a randomized controlled trial
Hsiao-Wen Tsai1, Peng-Hui Wang, Ming-Shyen Yen
1Department of Obstetrics and Gynecology, the Immunology Center, and the Department of Emergency Medicine, Taipei Veterans General Hospital, and the School of Medicine, the Institute of Clinical Medicine, and the Infection and Immunity Research Center, National Yang-Ming University, Taipei, Taiwan.
Objectives:
To estimate the effectiveness of combined intervention with the pulmonary recruitment maneuver and intraperitoneal normal saline infusion to reduce postlaparoscopic shoulder and upper abdominal pain.
Methods:
Patients were randomly assigned to undergo the combined intervention (n=50) or to a control group (n=50). Postlaparoscopic shoulder pain and upper abdominal pain were evaluated at 12, 24, and 48 hours postoperatively.
Results:
At 12, 24, and 48 hours, the incidence of laparoscopic-induced shoulder pain was lower in the intervention group (54%, 46%, and 30%, respectively) than in the control group (72%, 70%, and 50%, respectively; P=.008, P=.001, and P=.004, respectively). The number needed to treat for benefit to reduce shoulder pain incidence was six (95% confidence interval [CI], 4-21) at 12 hours, five (95% CI, 3-10) at 24 hours, and five (95% CI, 4-15) at 48 hours. The incidence of laparoscopic-induced upper abdominal pain also was lower in the intervention group (78%, 72%, and 58%, respectively) than in the control group (92%, 90%, and 70%, respectively) at 12, 24, and 48 hours postoperatively (P=.006, P=.001, and P=.077, respectively). The number needed to treat for benefit to reduce upper abdominal pain incidence was eight (95% CI, 5-24) at 12 hours and six (95% CI, 4-14) at 24 hours.
Conclusions:
Combined intervention with the pulmonary recruitment maneuver and intraperitoneal normal saline infusion is easy to implement in daily clinical practice to significantly reduce postlaparoscopic shoulder and upper abdominal pain.
