Yilmaz Gulseren, Kiyak Huseyin, Akca Aysu, Salihoglu Ziya
Department of Anesthesiology and Reanimation, University of Health Sciences, Faculty of Medicine, Kanuni Sultan Suleyman Hospital, Istanbul, Turkey.
Department of Obstetrics and Gynecology, University of Health Sciences, Faculty of Medicine, Kanuni Sultan Suleyman Hospital, Istanbul, Turkey.
Wideochir Inne Tech Maloinwazyjne. 2020 Sep;15(3):519-525. doi: 10.5114/wiitm.2019.89831. Epub 2019 Nov 18.
INTRODUCTION: The pulmonary recruitment maneuver (PRM) has emerged as an effective way of reducing post-laparoscopic shoulder pain (PLSP). However, the optimal lower pressure level for a PRM to reduce PLSP has not yet been investigated. AIM: To compare the efficacy of the low-pressure PRM with moderate-pressure PRM in preventing PLSP. MATERIAL AND METHODS: Seventy-two ASA I-II patients who were scheduled for gynecologic LS for non-malignant conditions were enrolled in this study. Group 1 included patients who received the PRM at a maximum pressure of 30-40 cm HO in a semi-Fowler position and group 2 included patients who received the PRM at a maximum pressure of 15 cm HO in a semi-Fowler position. The primary outcome of the study was the difference in PLSP between the two groups. RESULTS: There were no significant differences in PLSP and wound pain VAS scores between patients receiving the PRM at 30 cm HO and 15 cm HO during postoperative pain monitoring (p < 0.05). The groups were also similar with respect to ambulation time (p = 0.215), length of hospital stay (p = 0.556) and the height of the pneumoperitoneum measured on chest X-ray (p = 0.151). CONCLUSIONS: The low-pressure PRM (15 cm HO pressure) provides similar efficacy as the moderate-pressure PRM (30-40 cm HO) in terms of PLSP, wound pain, height of pneumoperitoneum, time of ambulation and length of hospital stay. We suggest that lower maximal inspiratory pressure of 15 cm HO might be preferred to avoid the potential complications of the PRM with higher pressures.
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