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Combination of a pulmonary recruitment maneuver and intraperitoneal bupivacaine for the reduction of postoperative shoulder pain in gynecologic laparoscopy: a randomized, controlled trial

Obstetrics & Gynecology Science 2020년 63권 2호 p.187 ~ 194
 ( Cho Min-Ae ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Obstetrics and Gynaecology

김철중 ( Kim Chul-Jung ) - Konyang University College of Medicine Department of Obstetrics and Gynecology
함태수 ( Hahm Tae-Soo ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Anesthesiology and Pain Medicine
이유영 ( Lee Yoo-Young ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Obstetrics and Gynecology
김태중 ( Kim Tae-Joong ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Obstetrics and Gynecology
이정원 ( Lee Jeong-Won ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Obstetrics and Gynaecology
김병기 ( Kim Byoung-Gie ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Obstetrics and Gynecology
배덕수 ( Bae Duk-Soo ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Obstetrics and Gynecology
최철훈 ( Choi Chel-Hun ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Obstetrics and Gynecology

Abstract


Objective: To compare the efficacy of a pulmonary recruitment maneuver using lower airway pressure (30 cm H2O) and intraperitoneal bupivacaine, alone or in combination, for reducing shoulder pain after gynecologic laparoscopy.

Methods: A prospective controlled study was performed in a teaching hospital with patients who underwent elective gynecologic laparoscopic surgery. Two hundred eighty-seven patients were randomized into 1 of 4 groups: group A, placebo; group B, intraperitoneal instillation of bupivacaine; group C, CO2 removal by a pulmonary recruitment maneuver; group D, combination of intraperitoneal bupivacaine and pulmonary recruitment maneuver. The interventions were performed at the end of surgery. Shoulder pain was recorded on a visual analog scale (VAS) at 1, 6, 12, and 24 hours postoperatively.

Results: The overall incidence of shoulder pain was 49.8% and the incidence tended to gradually decrease from group A to group D (59.0% in group A, 54.8% in group B, 44.4% in group C, and 41.5% in group D; P=0.026). In addition, the VAS scores gradually decreased from group A to D, although a statistically significant difference was only found at 6 hours postoperatively (P=0.03). There were no complications related to the interventions.

Conclusion: The combination of a pulmonary recruitment maneuver with intraperitoneal bupivacaine significantly reduced shoulder pain after gynecologic laparoscopy.

키워드

Gynecologic laparoscopy; Intraperitoneal bupivacaine; Pulmonary recruitment maneuver; Shoulder pain; VAS score
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