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2025, Number 6

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Acta Med 2025; 23 (6)

Comparison of alveolar recruitment maneuvers vs. passive abdominal compression in adults to reduce postoperative shoulder pain in laparoscopic surgery: a randomized clinical trial

Ruiz SR, Enríquez BA, Portela OJM, García HLA, Rueda EAA, Bracho BE, Ytuarte OE, Jiménez AS, Fierro JX, Poblano BA

Language: Spanish
References: 15
Page: 521-527
PDF size: 295.59 Kb.


ABSTRACT

Introduction: Post-laparoscopic shoulder pain (PLSP) is common and attributable to residual subdiaphragmatic CO2 after pneumoperitoneum; the alveolar recruitment maneuver (ARM) may aid its elimination, although protocol standardization is still lacking. Objective: to evaluate the efficacy of the alveolar recruitment maneuver (ARM) in reducing post-laparoscopic shoulder pain (PLSP) compared to passive abdominal compression (PAC). Material y methods: a randomized, double-blind clinical trial was conducted with 120 patients aged 18 to 65, ASA I-II, scheduled for laparoscopic surgery (cholecystectomy, hernioplasty, or appendectomy). Patients were assigned to either the ARMS group (n = 60), receiving PEEP of 15-20 cmH2O and Pmax of 30 cmH2O for two minutes at the end of the surgery, or the PAC group (n = 60), which received gentle abdominal compression with open ports. PLSP intensity was assessed using the visual analog scale at 6, 12, and 24 hours postoperatively. Results: at 6 hours postoperatively, 15% of the CAP group reported severe pain, while none in the ARM group experienced severe pain (p = 0.007). The incidence and severity of PLSP were significantly lower in the ARM group at all time points (p < 0.05). Conclusions: ARM is an effective and safe technique to reduce PLSP in laparoscopic surgery and may be considered for routine use. Originality: this study provides evidence for a lower-pressure ARM protocol, presenting an effective alternative for reducing PLSP.


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