Author(s): Dr. Bijoy Kumar Bandyopadhyay,
BACKGROUND To study the efficacy of pulmonary recruitment manoeuvre for removal of residual abdominal carbon dioxide after laparoscopic surgery to reduce shoulder pain and postoperative nausea and vomiting (PONV). METHODS A total of 70 patients undergoing gynaecological laparoscopic surgery were randomly allocated to control and intervention group. In control group, CO2 was removed by passive deflation of the abdominal cavity through the port site by applying gentle abdominal pressure. In intervention group, patients were placed in Trendelenburg position and CO2 was removed by means of a pulmonary recruitment manoeuvre consisting of five manual inflations of the lungs with a pressure of 40 cm of water, with the 5th inflation sustained for 5 seconds, with the trocar sleeve fully open. Postoperative shoulder pain (Visual Analogue Scale of 0–10) and PONV (0-3 scale) were observed as primary outcome, requirement of rescue analgesic and antiemetic (up to 48 hours), haemodynamic stability and respiratory function (up to 24 hours) were noted as secondary outcome. RESULTS Pain scores (at 0, 8, 12, 24 and 48 hours) and PONV grade (at 0, 4, 8, 12 and 24 hours) significantly reduced in intervention group. Requirement of rescue analgesic and antiemetic also reduced significantly in intervention group. No haemodynamic or respiratory function alteration was noted. CONCLUSIONS Application of five manual inflations of the lungs with a pressure of 40 cm of water, with the 5th inflation sustained for 5 seconds, with the trocar sleeve fully open, reduced shoulder pain as well as PONV after gynaecological laparoscopic surgery.