Department of Surgery, Vrinnevi Hospital, Gamla Övägen 25, 603 79, Norrköping, Sweden.
Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Norrköping, Sweden.
World J Surg. 2021 Dec;45(12):3575-3583. doi: 10.1007/s00268-021-06262-6. Epub 2021 Sep 5.
Pain and nausea are common after laparoscopic surgery. This prospective, randomized, controlled trial aimed to investigate postoperative pain and as a secondary endpoint nausea, when performing a ventilator-piloted Pulmonary Recruitment Maneuvre (PRM) at the end of laparoscopic cholecystectomy.
Patients having elective laparoscopic cholecystectomy were randomized to either ordinary exsufflation or ventilator-piloted PRM, to evacuate intra-abdominal carbon dioxide (CO) before abdominal closure. A questionnaire with numeric rating scales (NRS) was utilized to evaluate pain and nausea at five occasions during 48 h following surgery. Analgesic and antiemetic treatment was also analyzed.
147 patients were analyzed, 76 receiving PRM and 71 controls. Overall pain was well controlled, with no significant difference between the groups regarding incidence (P=0.149) nor intensity (P=0.739). Incidence of shoulder pain was lower in the PRM group during the 48 postoperative hours, 44.7% versus 63.4% (P=0.023). The number needed to treat (NNT) to reduce shoulder pain was 6 (95% Confidence Interval, CI, 2.9-35.5) for the 48-h period. Incidence of nausea was lower in the PRM group during the 48-h period, 51.3% versus 70.4% (P=0.018). NNT was 6 (95% CI 2.9-27.4) for the 48-h period. Nausea intensity was lower in the PRM group during the 48 h (P=0.025). Fewer in the PRM population required antiemetics, 25.0% versus 42.3% (P=0.027).
A ventilator-piloted PRM at the end of laparoscopic cholecystectomy reduced incidence of shoulder pain, and incidence and intensity of nausea. Clinical trial registration www.clinicaltrials.gov . Identifier: NCT03026543.
腹腔镜手术后常出现疼痛和恶心。本前瞻性、随机、对照试验旨在研究腹腔镜胆囊切除术后行呼吸机驱动肺复张（PRM）时，术后疼痛和恶心的情况。
选择择期行腹腔镜胆囊切除术的患者，随机分为普通吹气量组或呼吸机驱动 PRM 组，在关腹前排空腹腔内二氧化碳（CO）。术后 48 小时内，使用数字评分量表（NRS）评估 5 个时间点的疼痛和恶心情况，并分析镇痛和止吐治疗情况。
共分析了 147 例患者，76 例接受 PRM，71 例为对照组。两组总体疼痛控制良好，发生率（P=0.149）和强度（P=0.739）无显著差异。PRM 组术后 48 小时内肩部疼痛发生率较低，为 44.7%，对照组为 63.4%（P=0.023）。减少 48 小时肩部疼痛的需要治疗人数（NNT）为 6（95%置信区间，CI，2.9-35.5）。PRM 组术后 48 小时内恶心发生率较低，为 51.3%，对照组为 70.4%（P=0.018）。NNT 为 48 小时内 6（95% CI 2.9-27.4）。PRM 组术后 48 小时内恶心强度较低（P=0.025）。PRM 组需要止吐药的人数较少，为 25.0%，对照组为 42.3%（P=0.027）。
腹腔镜胆囊切除术后行呼吸机驱动 PRM 可降低肩部疼痛发生率，以及恶心的发生率和强度。
临床试验注册 www.clinicaltrials.gov. 标识符：NCT03026543。
