Use of intraoperative mild hyperventilation to decrease the incidence of postoperative shoulder pain after...

Area of Science:

• Bariatric Surgery
• Anesthesiology
• Pain Management

Background:

• Post-laparoscopic shoulder pain (PLSP) is a frequent complication following minimally invasive surgery.
• It arises from phrenic nerve irritation, often managed with various interventions.
• Mild intraoperative hyperventilation is explored as a novel strategy to mitigate PLSP.

Purpose of the Study:

• To evaluate the efficacy of mild intraoperative hyperventilation in reducing PLSP incidence and severity.
• To assess the impact of this technique on analgesic requirements and postoperative nausea and vomiting.
• To investigate the long-term effects of mild hyperventilation on PLSP following laparoscopic sleeve gastrectomy (LSG).

Main Methods:

• A randomized controlled trial involving patients undergoing LSG.
• Patients were assigned to either mild hyperventilation (target ETCO2 30-32 mmHg) or conventional ventilation (ETCO2 35-40 mmHg).
• PLSP incidence, severity, analgesic use, and nausea/vomiting were recorded at multiple time points up to 3 months postoperatively.

Main Results:

• While PLSP incidence was similar in the first 24 hours, the mild hyperventilation group showed significantly lower rates at 36 hours, 48 hours, 1 week, and 1 month (P < 0.05).
• The mild hyperventilation group reported significantly lower average PLSP pain scores throughout the follow-up period.
• Nausea and vomiting incidence were non-significantly lower in the mild hyperventilation group.

Conclusions:

• Mild intraoperative hyperventilation demonstrates significant potential in reducing the incidence and severity of PLSP after LSG.
• This anesthetic technique may offer a valuable method for improving patient outcomes and comfort post-laparoscopic surgery.
• Further research may explore broader applications of intraoperative hyperventilation in other laparoscopic procedures.