Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
J Anesth. 2024 Dec;38(6):839-847. doi: 10.1007/s00540-024-03403-8. Epub 2024 Sep 14.
Lung-recruitment maneuvers (LRM) have been shown to reduce postoperative pain after laparoscopic surgery. This study aimed to investigate the association of LRM with the incidence of shoulder pain after laparoscopic cholecystectomy.
A randomized controlled study was conducted with 110 patients undergoing elective laparoscopic cholecystectomy from July 2022 to March 2023. Participants were randomized to receive either routine exsufflation or LRM at pneumoperitoneum release. The postoperative shoulder pain and abdominal pain were assessed at 1, 4, 6, 12, and 24 h after surgery using a numeric rating scale. Analgesic consumption and postoperative nausea or vomiting (PONV) were evaluated during the first 24 h after surgery.
The incidence of shoulder pain during the first 24 h after surgery was significantly lower in the LRM group compared to the control group (26.9 vs. 59.3%; P = 0.001). The median [interquartile range] score of worst shoulder pain was significantly lower compared to the control group (3 [2-3] vs 4 [3-5.5]; P = 0.003). Participants in the LRM group showed reduced abdominal pain at rest at 4 and 24 h after surgery, and experienced significantly lower intensities of abdominal pain during mobilization at all time points over 24 h after surgery. There were no significant differences in opioid consumption or the incidence of PONV between the groups.
LRM reduces both the incidence and intensity of shoulder pain during 24 h after laparoscopic cholecystectomy. Additionally, LRM was associated with reduced intensity of abdominal pain during mobilization over the study period.
肺复张手法（LRM）已被证明可减少腹腔镜手术后的术后疼痛。本研究旨在探讨 LRM 与腹腔镜胆囊切除术（LC）后肩痛发生率的关系。
这是一项于 2022 年 7 月至 2023 年 3 月进行的随机对照研究，纳入 110 例行择期 LC 的患者。参与者随机接受常规呼气或气腹释放时 LRM。术后 1、4、6、12 和 24 小时采用数字评分量表评估肩痛和腹痛。术后 24 小时内评估镇痛药物消耗和术后恶心或呕吐（PONV）。
LRM 组术后 24 小时内肩痛发生率明显低于对照组（26.9%比 59.3%；P=0.001）。LRM 组最差肩痛评分中位数[四分位距]明显低于对照组（3[2-3]比 4[3-5.5]；P=0.003）。LRM 组术后 4 和 24 小时静息时腹部疼痛减轻，术后 24 小时内各时间点活动时腹部疼痛强度明显降低。两组间阿片类药物消耗或 PONV 发生率无差异。
LRM 可降低 LC 后 24 小时内肩痛的发生率和强度。此外，LRM 与研究期间活动时腹痛强度降低有关。
