Semi-Fowler positioning in addition to the pulmonary recruitment manoeuvre reduces shoulder pain following gynaecologic laparoscopic surgery

Introduction: The semi-Fowler position, defined as a body position at 30 degrees head-of-bed elevation, has been shown to increase intra-abdominal pressure. Aim: To investigate the impact of semi-Fowler positioning in addition to the pulmonary recruitment manoeuvre (PRM) on post-laparoscopic shoulder pain. Material and methods: One hundred and six patients (mean age: 43 +/- 12 years) undergoing gynaecologic laparoscopic surgery (LS) were included. The patients were divided into three groups: group 1 consisted of patients receiving PRM in the neutral position, group 2 comprised patients receiving PRM in the semi-Fowler position, and patients in the control group received neither PRM nor additional positioning. Information concerning wound and shoulder pain (post-laparoscopic shoulder pain - PLSP) at postoperative 6, 12 and 24 h was recorded using a visual analogue scale (VAS) for each patient. Results: The PLSP scores at postoperative 6 h (5.71 +/- 0.86, 5.28 +/- 0.84 and 6.61 +/- 0.91, respectively, p < 0.001), 12 h (4.41 +/- 0.83, 4.01 +/- 0.82 and 5.32 +/- 0.97, respectively, p < 0.001), and 24 h (3.24 +/- 0.78, 2.44 +/- 0.73 and 4.34 +/- 0.85, respectively, p < 0.001) were significantly different among the groups, the lowest being in those who received PRM in addition to semi-Fowler positioning. Conclusions: Semi-Fowler positioning in addition to PRM significantly reduces post-laparoscopic shoulder pain. We assume that the benefit gained using the semi-Fowler positioning is mainly derived from its potential to better evacuate the remaining abdominal gas following LS.