Prevention of Postlaparoscopic Shoulder and Upper Abdominal Pain A Randomized Controlled Trial

OBJECTIVES: To estimate the effectiveness of combined intervention with the pulmonary recruitment maneuver and intraperitoneal normal saline infusion to reduce postlaparoscopic shoulder and upper abdominal pain. METHODS: Patients were randomly assigned to undergo the combined intervention (n = 50) or to a control group (n = 50). Postlaparoscopic shoulder pain and upper abdominal pain were evaluated at 12, 24, and 48 hours postoperatively. RESULTS: At 12, 24, and 48 hours, the incidence of laparoscopic-induced shoulder pain was lower in the intervention group (54%, 46%, and 30%, respectively) than in the control group (72%, 70%, and 50%, respectively; P = .008, P = .001, and P = .004, respectively). The number needed to treat for benefit to reduce shoulder pain incidence was six (95% confidence interval [CI], 4-21) at 12 hours, five (95% CI, 3-10) at 24 hours, and five (95% CI, 4-15) at 48 hours. The incidence of laparoscopic-induced upper abdominal pain also was lower in the intervention group (78%, 72%, and 58%, respectively) than in the control group (92%, 90%, and 70%, respectively) at 12, 24, and 48 hours postoperatively (P=.006, P=.001, and P=.077, respectively). The number needed to treat for benefit to reduce upper abdominal pain incidence was eight (95% CI, 5-24) at 12 hours and six (95% CI, 4-14) at 24 hours. CONCLUSIONS: Combined intervention with the pulmonary recruitment maneuver and intraperitoneal normal saline infusion is easy to implement in daily clinical practice to significantly reduce postlaparoscopic shoulder and upper abdominal pain.