Post Laparoscopy Shoulder Pain and Postoperative Trendelenburg Position

Not Applicable

Completed

Brief Summary: 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 a major contributor to post operative shoulder pain. Shoulder pain post laparoscopy is common and it is a major cause of patient dissatisfaction. The aim of our study is to evaluate the efficacy of positioning the patient in Trendelenburg, post operatively for 24 hours, on shoulder pain reduction. Our hypothesis is based on the assumption that complete CO2 deflation is not possible and that Trendelenburg positioning will help displace CO2 from the sub diaphragmatic area thus reducing the diaphragmatic and phrenic nerve irritation causing pain.

Detailed Description: A prospective randomized controlled study with 54 patients in each of the two arms. Group S (control) will undergo the standard laparoscopic procedure and the patients will be placed in supine head up position postoperatively. In group T (interventional); the patients will be positioned in Trendelenburg position once fully awake and cooperative in the post-anesthesia case unit (PACU) and will remain in this position for the first 24 hours postoperatively. Postoperative NRS(numeric rating scale) score for shoulder pain and nausea will be collected at arrival to PACU, \& 4, 6, 12 and 24 hours postoperatively. In addition, total amount of rescue pain and nausea medication used by the patient will be recorded. Data collected will be analyzed and compared between the two groups. The independent t- test will be used to compare postoperative shoulder pain, with NRS scores treated as continuous variable, between the two groups.

Recruitment & Eligibility

Inclusion Criteria

Female patients
Age: 18 years to 60 years, American Society of Anesthesiologist physical status (ASA) 1 or 2
Diagnostic or operative gynecologic laparoscopy {4 port sites, three 5 mm trocars (suprapubic, right and left iliac fossa) and one 10 mm trocar (umbilical)} between one and 3 hours duration.
Abdominal incisions less than 1.5 cm.
Steady abdominal insufflation pressure of 14 mm Hg following a gradual insufflation over a 5-minute period.
Insufflation at a steady maximal flow of 30 l/min

Exclusion Criteria

Arm && Interventions

Group	Intervention	Description
Group T	20 degree Trendelenburg position	Intervention group (Group T: 54 patients); the patients will be subject to the same maneuver as in arm 1 prior to wound closure but will be positioned in a 20 degree Trendelenburg position once fully awake and cooperative in the PACU and will remain in this position for the first 24 hours post operatively, even after they are transferred to their rooms on the American University of Beirut Medical Center (AUBMC) floors. The maximum time allowed in a straight-up position will be three 15-minute intervals over a 24-hour period (the first interval being a clear fluids intake at 12 hours postoperatively).

Primary Outcome Measures

Name	Time	Method
Shoulder pain (12 hours)	12 hours after laparoscopic surgery	Pain score (measured using a 0-10 numerical scale) at 12 hours

Secondary Outcome Measures

Name	Time	Method
Shoulder pain	at arrival to post anesthesia care unit (PACU), 4, 6, and 24 hours, after laparoscopic surgery	Pain score (measured using a 0-10 numerical scale)
Presence of nausea	at arrival to PACU, 4, 6, 12 and 24 hours, after laparoscopic surgery	Presence or absence of nausea (yes/no)
Severity of Nausea	at arrival to PACU, 4, 6, 12 and 24 hours, after laparoscopic surgery	Nausea score (measured using a 0-10 numerical scale)
Rescue pain medication	within first 24 hours after laparoscopic surgery	Time to first rescue pain medication (minutes)
Total rescue pain medication	within first 24 hours after laparoscopic surgery	Total rescue pain medication during first 24 hours
Patient satisfaction	24 hours post laparoscopic surgery	Patient satisfaction with surgical experience (measured using a 0-10 numerical scale)

Locations (1): American University of Beirut Medical Center
🇱🇧
Beirut, Lebanon