Effect of postoperative Trendelenburg position on shoulder pain after gynecological laparoscopic procedures: a randomized clinical trial
Carine Zeeni,Dina Chamsy,Ali Khalil,Antoine Abu Musa,Majed Al Hassanieh,Fadia Shebbo,Joseph Nassif +6 more
TL;DR: In conclusion, Trendelenburg position is an easy non-pharmacologic intervention that is beneficial in reducing postoperative shoulder pain following gynecologic laparoscopic surgery.
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Abstract: Laparoscopic surgery has become a standard of care for many gynecological surgeries due to its lower morbidity, pain and cost compared to open techniques. Unfortunately, the use of carbon dioxide (CO2) to insufflate the abdomen is the main contributor to post-operative shoulder pain. We aim to assess the effect of postoperative Trendelenburg position on shoulder pain after gynecological laparoscopic procedures. We hypothesize that maintaining the patient in Trendelenburg for 24 h postoperatively will significantly decrease postoperative shoulder pain and analgesic consumption. After obtaining written informed consent, 108 patients were prospectively randomized into two groups. In the control group, patients underwent standard gynecologic laparoscopic procedures; then after passive deflation of the pneumoperitoneum at the end of the surgery, the patients were placed in supine head up position in the post anesthesia care unit (PACU) and received our institution’s common postoperative care. Patients in the intervention group were subjected to the same maneuver but were positioned in a Trendelenburg position (20 °) once fully awake and cooperative in the PACU and retained this position for the first 24 h. Numerical rating scale (NRS) was used to assess shoulder pain and nausea upon patient arrival to the PACU, at 4, 6, 12 (primary outcome) and 24 h postoperatively. Time to first rescue pain medication, total rescue pain medications and overall satisfaction with pain control were recorded. 101 patients were included in the final data analysis. Both groups were comparable in terms of baseline characteristics. NRS pain scores were significantly lower in the intervention group at 12 h compared to the control group (0 [0–1] versus 5 [1–4], p < 0.001), furthermore improvement in postoperative shoulder pain between time of arrival to PACU (time zero) and 12 h postoperatively was significantly higher in patients allocated to the experimental group compared to the control group. Pain scores were significantly lower in patients allocated to the experimental group versus the control group (0 [0–1] versus 5 [1–4], p < 0.001). In conclusion, Trendelenburg position is an easy non-pharmacologic intervention that is beneficial in reducing postoperative shoulder pain following gynecologic laparoscopic surgery. Retrospectively registered at Clinicaltrials.gov, registration number NCT04129385, date of registration: June 28, 2019
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Citations
The Effect of Manual Maneuver on Shoulder Pain of Laparoscopic Gynecology Surgery, a Randomized Clinical Trial Study
Fatemeh Salehi,Saeideh Shams Zamenjani,Shima Rahimi,Mina Fatehnejad,Elham Feizabad,Sara Saeedi +5 more
TL;DR: This randomized clinical trial found that manual abdominal massage after laparoscopic gynecology surgery significantly reduced shoulder pain and analgesic use, with a 24-hour pain intensity decrease of 1.5 points in the intervention group compared to the control group.
The Effect of Postoperative Modified Trendelenburg Position to Decrease Shoulder Pain after Laparoscopic Hysterectomy: A Randomized Controlled Trial
Kamaitorn Tientong
Abstract: Abstract Objectives: The objective of this study was to investigate the impact of postoperative modified Trendelenburg posture on shoulder pain after laparoscopic hysterectomy (TLH). Materials and Methods: Forty-six patients undergoing TLH for benign gynecologic conditions were prospectively enrolled in a randomized controlled trial with a 1:1 allocation ratio. At the postoperative ward, patients in the intervention group were placed in a modified Trendelenburg posture with a 20° inclination for 6 h, while those in the control group were maintained supine. Shoulder pain was evaluating using a Numerical Rating Scale (NRS) at intervals of 0, 6, 12, and 24 h postoperatively upon admission to the postoperative ward. Additionally, scores for upper abdominal pain, lower abdominal pain, nausea/vomiting, as well as the total consumption of rescue analgesia and antiemetic drugs within the first 24 h following surgery were recorded . Results: The baseline characteristics exhibited no significant differences between the two groups. Furthermore, when evaluating the NRS of shoulder pain, no statistically significant difference was observed between the two groups ( P = 0.363). Additionally, no notable distinctions emerged in the scores associated with upper abdominal pain, lower abdominal pain, nausea/vomiting, or the overall usage of rescue analgesics and antiemetic medications within the initial 24 h following the surgical procedure. Conclusion: Implementing a modified Trendelenburg posture for a duration of 6 h after TLH did not have a significant impact on reducing shoulder discomfort.
Effect of Shoulder Movement Routine on Postoperative Shoulder Pain in Total Laparoscopic Hysterectomy: A Randomized Clinical Trial
Andrea Alicia Olguín Ortega,Lino Palacios‐Cruz,Alejandro Rendón-Molina,Oliver Cruz-Orozco,Brenda Sánchez-Ramírez,Silvia Fabiola Estrada-Rivera,José Roberto Silvestri-Tomassoni,Ana Cristina Arteaga-Gómez,Enrique Reyes-Muñoz +8 more
TL;DR: This randomized clinical trial investigates the effect of a shoulder movement routine on postoperative shoulder pain in women undergoing total laparoscopic hysterectomy, a common complication of the procedure.
Effect of the Trendelenburg position, Deep Breathing Exercise, and Warm Water Application on Shoulder Pain and Post-gynecologic Laparoscopic Recovery
Afaf Hassan Ahmed,Naglaa Fathalla,Noha Mahmoud,Zohour Ibrahim Rashwan,Abeer Hassan Shamekh Taman +4 more
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