Randomised controlled trial to estimate reduction in pain after laparoscopic surgery when using a combination therapy of intraperitoneal normal saline and the pulmonary recruitment manoeuvre

Objective: To evaluate the effect of two manoeuvres at the end of gynaecological laparoscopy on postoperative pain. Design: Randomised controlled trial. Setting: One teaching and one university hospital in the Netherlands. Sample: Women aged between 18 and 65 years, with American Society of Anaesthesiologists (ASA) classification I–II, scheduled for an elective laparoscopic procedure for a benign gynaecological indication. Methods: Women were randomly allocated to two groups. In the intervention group, carbon dioxide was removed from the abdomen by a combination treatment of intraperitoneal warm saline and performing a pulmonary recruitment manoeuvre. In the control group, carbon dioxide was removed with gentle abdominal pressure. Main outcome measures: Frequency and intensity of post-laparoscopic shoulder pain and pain in the upper abdomen at 8, 24, and 48 hours after surgery. Results: A total of 200 women participated, with 100 in each group. No difference was observed in the occurrence of post-laparoscopic shoulder pain during the first 48 hours after surgery between the intervention group (46%) and the control group (55%). The incidence of abdominal pain was not significantly different between the two groups. The mean visual analogue scale (VAS) scores of participants who reported shoulder pain were not statistically different between the groups. The mean VAS score for abdominal pain at 8 hours after surgery was significantly lower in the intervention group compared with the control group (3.2 versus 4.2, P = 0.02). No difference in pain medication between the groups was observed, nor was there any difference in nausea or vomiting. Conclusions: Combined intervention of intraperitoneal saline and the pulmonary recruitment manoeuvre does not lower post-laparoscopic shoulder pain. Tweetable abstract: PRM with intraperitoneal saline does not influence the incidence and intensity of post-laparoscopic shoulder pain.