Faculty of Health Sciences, Universidad Anáhuac / Hospital Angeles Lomas, Vialidad de la Barranca s/n, C 410, Valle de Las Palmas, Huixquilucan, Estado de México, 52774, México.
Surg Endosc. 2021 Aug;35(8):4143-4152. doi: 10.1007/s00464-020-07881-1. Epub 2020 Aug 17.
This study is aimed to evaluate the pulmonary recruitment maneuver as a means to effectively reduce residual pneumoperitoneum and postoperative shoulder pain in patients undergoing conventional laparoscopic procedures and compare it to the instillation of intraperitoneal anesthetics.
Patients undergoing laparoscopic cholecystectomy, appendectomy or hernioplasty were randomized into two groups: pulmonary recruitment maneuver (PRM) and intraperitoneal anesthetic instillation (IAI). Six hours after surgery patients were asked to fill out a visual analog scale to identify shoulder pain and a chest X-ray was taken. Groups were analyzed for incidence of residual pneumoperitoneum and shoulder pain as well as for volume of residual subdiaphragmatic gas and intensity of pain.
A total of 84 patients (42 per group) were included in the study. Patients in the PRM group had a lower incidence of subdiaphragmatic gas present in the chest X-ray (29% vs 55%) p = 0.01 and less volume of residual pneumoperitoneum (mean difference -.31(95%CI -7.36, 0.72), p = 0.02). They also were half as likely to present shoulder pain (24% vs 50%) p = 0.01 and showed less pain intensity than those in the IAI group (mean difference -2.04(95%CI - 3.25, - 0.84), p = 0.000). The risk of presenting shoulder pain when residual pneumoperitoneum was present showed an RR = 11.1, p = 0.0001 in the PRM group and an RR = 8.3, p = 0.000 in the IAI group. The volume of subdiaphragmatic gas was positively correlated with the intensity of shoulder pain (r = 0.54, p = 0.000).
The pulmonary recruitment maneuver is effective in reducing the incidence and volume of residual pneumoperitoneum, as well as the incidence and intensity of shoulder pain in patients undergoing conventional laparoscopic procedures.
本研究旨在评估肺复张手法作为一种有效减少常规腹腔镜手术中残余气腹和术后肩部疼痛的方法，并将其与腹腔内麻醉剂注入进行比较。
接受腹腔镜胆囊切除术、阑尾切除术或疝修补术的患者被随机分为两组：肺复张手法（PRM）和腹腔内麻醉剂注入（IAI）。手术后 6 小时，患者填写视觉模拟评分表以识别肩部疼痛，并拍摄胸部 X 光片。分析两组残余气腹和肩部疼痛的发生率以及膈下残留气体量和疼痛强度。
共有 84 名患者（每组 42 名）纳入研究。PRM 组患者胸部 X 光片显示膈下气体存在的发生率较低（29%比 55%，p=0.01），残余气腹量较少（平均差异-.31（95%CI -7.36，0.72），p=0.02）。他们出现肩部疼痛的可能性也减半（24%比 50%，p=0.01），且疼痛强度低于 IAI 组（平均差异-2.04（95%CI -3.25，-0.84），p=0.000）。当存在残余气腹时，出现肩部疼痛的风险在 PRM 组中为 RR=11.1，p=0.0001，在 IAI 组中为 RR=8.3，p=0.000。膈下气体量与肩部疼痛强度呈正相关（r=0.54，p=0.000）。
肺复张手法可有效降低常规腹腔镜手术中残余气腹的发生率和量，以及肩部疼痛的发生率和强度。
