Rami A. Abudayyeh*, Omar Y. Abu-Zeitoun, Omar A.Al-shawabkeh, Talal Jalabneh, Elias A. Shamoun, Fares S.L. Al-maaitah, Ghaseb A.K. Abu-Alghawai, Mohammed M. Hiasat, Ra’ad S.A. Alqaisi, Mohammad Zaid S. Al-Abbadi AND Nail M. Al-Shanableh


Background: Laparoscopic surgery is more superior in rapid emergence. Laparoscopic surgery requires smaller incisions, has less pain after surgery compared to laparotomy. The frequency of shoulder pain following laparoscopic gynecologic surgery is 80%. Goal: To determine influence of intraperitoneal infusion of normal saline by surgeons or lung recruitment technique by anesthesiologists on the diminution of pain at shoulder and incision locations following elective laparoscopic surgery. Methods: Our prospective, randomized and double-blind study enrolled 120 patients, average aged 42.4 yrs. [31-55], American Society of Anesthesiologists physical status I, of both sexes and scheduled for different elective laparoscopic surgery at King Hussein hospital, KHMC hospital, Amman, Jordan, during the period Jan 2020 – Jan 2021.Patients were divided in three groups. Group I patients had intraperitoneal administration of saline with 1-2 ml/kg while group II patients had respiratory recruitment using 5 manual inflations at 60 cm H2Oand group III patients had mild abdominal pressure. All patients were evaluated during the 1st postoperative day. Outcomes were pain in shoulder or incision locations, and side effects were nausea, vomiting and distension. These were recorded instantly postoperatively and at 1, 4, 10 and 24 hours postoperatively. Verbal analog scale (VAS) was used to determine the pain severity (0: no pain;1-3: mild pain;4-7:moderate pain;8-10:severe pain). Multivariate ANOVA calibrated for agewas used to analyze the influence of procedures and duration on the outcome (shoulder pain and the incision locations pain). Results: There was a discrepant profile for pain in shoulder and incision locations at various time intervals within the different groups. Patients in group II experienced remarkably less shoulder pain one day following laparoscopic surgery (P = 0.04) and patients in group III experienced remarkably less incision location pain (P < 0.003). Interaction of time interval with procedure condition was remarkable for shoulder and incision locations pain (P <0.02). Conclusions: Lung recruitment technique with soft abdominal pressure was better than intraperitoneal infusion of normal saline 0.9% with soft abdominal pressure for diminution of pain in the first day following elective laparoscopic surgery.

Keywords: Lung Recruitment; Intraperitoneal Infusion; Laparoscopy; Pain.

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