Randomised controlled trial to estimate reduction in pain after laparoscopic surgery when using a combination therapy of intraperitoneal normal saline and the pulmonary recruitment manoeuvre

J. E. W. van Dijk*, S. J. Dedden, P. M. A. J. Geomini, S. M. J. van Kuijk, N. van Hanegem, P. Meijer, M. Y. Bongers

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

7 Citations (Web of Science)


ObjectiveTo evaluate the effect of two manoeuvres at the end of gynaecological laparoscopy on postoperative pain.

DesignRandomised controlled trial.

SettingOne teaching and one university hospital in the Netherlands.

SampleWomen aged between 18 and 65 years, with American Society of Anaesthesiologists (ASA) classification I-II, scheduled for an elective laparoscopic procedure for a benign gynaecological indication.

MethodsWomen were randomly allocated to two groups. In the intervention group, carbon dioxide was removed from the abdomen by a combination treatment of intraperitoneal warm saline and performing a pulmonary recruitment manoeuvre. In the control group, carbon dioxide was removed with gentle abdominal pressure.

Main outcome measuresFrequency and intensity of post-laparoscopic shoulder pain and pain in the upper abdomen at 8, 24, and 48 hours after surgery.

ResultsA total of 200 women participated, with 100 in each group. No difference was observed in the occurrence of post-laparoscopic shoulder pain during the first 48 hours after surgery between the intervention group (46%) and the control group (55%). The incidence of abdominal pain was not significantly different between the two groups. The mean visual analogue scale (VAS) scores of participants who reported shoulder pain were not statistically different between the groups. The mean VAS score for abdominal pain at 8 hours after surgery was significantly lower in the intervention group compared with the control group (3.2 versus 4.2, P = 0.02). No difference in pain medication between the groups was observed, nor was there any difference in nausea or vomiting.

ConclusionsCombined intervention of intraperitoneal saline and the pulmonary recruitment manoeuvre does not lower post-laparoscopic shoulder pain.

FundingThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Tweetable abstractPRM with intraperitoneal saline does not influence the incidence and intensity of post-laparoscopic shoulder pain.

Tweetable abstract PRM with intraperitoneal saline does not influence the incidence and intensity of post-laparoscopic shoulder pain.

Original languageEnglish
Pages (from-to)1469-1476
Number of pages8
JournalBjog-an International Journal of Obstetrics and Gynaecology
Issue number11
Publication statusPublished - Oct 2018


  • Intraperitoneal saline
  • post-laparoscopic pain
  • pulmonary recruitment manoeuvre
  • shoulder pain

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