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      Effect of abdominal binder on shoulder pain after laparoscopic gynecologic surgery: A randomized, controlled trial

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Background:

          To evaluate the impact of abdominal binder (AB) use on postoperative shoulder pain in patients recovering from laparoscopic gynecologic surgery.

          Methods:

          This was a prospective randomized study conducted in a tertiary teaching hospital. Overall, 144 patients underwent laparoscopic gynecologic surgery. The postoperative use of an AB for 24 hours was added to the pulmonary recruitment maneuver.

          Results:

          Of 144 consenting patients, 72 patients each were allocated to the AB and control groups, respectively, and 14 patients were excluded. Finally, 130 patients were analyzed, with 68 in the AB group and 62 in the control group. There was no difference in the incidence of postoperative shoulder pain between the 2 groups (55.9% vs 56.5%, P = 1.000). The severity of the worst shoulder pain, measured using a numerical rating scale, did not differ between the 2 groups (Median [interquartile range] 2 [0–5] vs 2 [0–5]; P = .865). The severity of surgical site pain, pain and nausea medications, and the ambulation time were not different in the 2 groups.

          Conclusion:

          The use of an AB was not beneficial for postoperative shoulder pain following laparoscopic gynecologic surgery. Surgical site pain, ambulation time, and postoperative nausea and vomiting were not improved with the use of an AB.

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          Most cited references23

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          What is normal intra-abdominal pressure and how is it affected by positioning, body mass and positive end-expiratory pressure?

          Manu Malbrain, L. La Rotonda, Elizabeth Gier … (2009)
          To describe what is defined as normal intra-abdominal pressure (IAP) and how body positioning, body mass index (BMI) and positive end-expiratory pressure (PEEP) affect IAP monitoring. A review of different databases was made (Pubmed, MEDLINE (January 1966-June 2007) and EMBASE.com (January 1966-June 2007)) using the search terms of "IAP", "intra-abdominal hypertension" (IAH), "abdominal compartment syndrome" (ACS), "body positioning", "prone positioning", "PEEP" and "acute respiratory distress syndrome" (ARDS). Prior to 1966, we selected older articles by looking at the reference lists displayed in the more recent papers. This review focuses on the concept that the abdomen truly behaves as a hydraulic system. The definitions of a normal IAP in the general patient population and morbidly obese patients are reviewed. Subsequently, factors that affect the accuracy of IAP monitoring, i.e., body position (head of bed elevation, lateral decubitus and prone position) and PEEP, are explored. The abdomen behaves as a hydraulic system with a normal IAP of about 5-7 mmHg, and with higher baseline levels in morbidly obese patients of about 9-14 mmHg. Measuring IAP via the bladder in the supine position is still the accepted standard method, but in patients in the semi-recumbent position (head of the bed elevated to 30 degrees and 45 degrees ), the IAP on average is 4 and 9 mmHg, respectively, higher. Future research should be focused on developing and validating predictive equations to correct for supine IAP towards the semi-recumbent position. Small increases in IAP in stable patients without IAH, turned prone, have no detrimental effects. The role of prone positioning in the unstable patient with or without IAH still needs to be established.
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            Prospective randomized trial of low-pressure pneumoperitoneum for reduction of shoulder-tip pain following laparoscopy.

            L Roncoroni, R Costi, L Sarli … (2000)
            Postoperative shoulder-tip pain occurs frequently following laparoscopic cholecystectomy. The aim of this randomized clinical trial was to evaluate the efficacy of a low-pressure carbon dioxide pneumoperitoneum during laparoscopic surgery in reducing the incidence of postoperative shoulder-tip pain. Ninety consecutive patients undergoing laparoscopic cholecystectomy were randomized prospectively into low-pressure (group A) and normal-pressure (group B) laparoscopic cholecystectomy groups. Patients in group A (n = 46) underwent laparoscopic cholecystectomy with 9 mmHg carbon dioxide pneumoperitoneum during most of the operation, and those in group B (n = 44) had laparoscopic cholecystectomy with 13 mmHg pneumoperitoneum. Shoulder-tip pain was recorded on a visual analogue pain scale 1, 3, 6, 12, 24 and 48 h after operation. The low-pressure pneumoperitoneum did not increase the duration of surgery. There were no significant intraoperative or postoperative complications in either group. Fourteen patients (32 per cent) in group B and five (11 per cent) in group A complained of shoulder pain (P<0.05). Mean shoulder-tip pain scores at 12 and 24 h and postoperative analgesia requirements were also significantly lower in the low-pressure laparoscopic cholecystectomy group (P<0.001). A carbon dioxide pneumoperitoneum pressure lower than that usually utilized to perform laparoscopic surgery reduces both the frequency and intensity of shoulder-tip pain following laparoscopic cholecystectomy.
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              A simple clinical maneuver to reduce laparoscopy-induced shoulder pain: a randomized controlled trial.

              C Radke, Tara P Phelps, O Cakmakkaya … (2008)
              To estimate the efficacy of a simple clinical maneuver that facilitates removal of residual abdominal carbon dioxide (CO2) after laparoscopic surgery to reduce shoulder pain. A total of 116 female outpatients who were scheduled for elective gynecologic laparoscopic surgery were randomly allocated to either the current standard (control group) or to additional efforts to remove residual CO2 at the end of surgery. In the control group, CO2 was removed by passive deflation of the abdominal cavity through the cannula. In the intervention group, CO2 was removed by means of Trendelenburg position (30 degrees) and a pulmonary recruitment maneuver consisting of five manual inflations of the lung. Postoperative shoulder pain was assessed before discharge and 12, 24, 36, and 48 hours later using a visual analog scale (VAS, 0-100). In addition, positional characteristics of the shoulder pain and incidence of postdischarge nausea and vomiting were recorded until 48 hours after discharge. Pain scores in the control and intervention groups were 30.3+/-4.5 compared with 15.6+/-3.0, 25.7+/-4.7 compared with 10.8+/-2.4, and 21.7+/-4.3 compared with 9.1+/-2.5 at 12, 24 and 36 hours after discharge, respectively (all P<.05). The intervention reduced positional pain from 63% to 31% (P<.05) and the incidence of postoperative nausea and vomiting from 56.5% to 20.4% (P<.001). This simple clinical maneuver at the end of surgery reduced shoulder pain as well as postoperative nausea and vomiting after laparoscopic surgery by more than half. www.clinicaltrials.gov, ClinicalTrials.gov, NCT00575237 I.
              Article 0 comments Cited 35 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Yoon Jung Kim
                So Yeong Hwang
                Journal
                Journal ID (nlm-ta): Medicine (Baltimore)
                Journal ID (publisher-id): MD
                Title: Medicine
                Publisher: Lippincott Williams & Wilkins (Hagerstown, MD )
                ISSN (Print): 0025-7974
                ISSN (Electronic): 1536-5964
                Publication date Collection: 23 June 2023
                Publication date (Electronic): 23 June 2023
                Volume: 102
                Issue: 25
                Electronic Location Identifier: e34127
                Affiliations
                [a ]Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
                Author notes
                * Correspondence: Hee-Soo Kim, Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Korea (e-mail: dami0605@ 123456snu.ac.kr ).
                Author information
                https://orcid.org/0000-0002-2661-7944
                Article
                Accession ID: 00031
                DOI: 10.1097/MD.0000000000034127
                PMC ID: 10289768
                SO-VID: b53a8a11-fb8d-4a54-9654-83b8ffc722c8
                Copyright © Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.
                License:

                This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 19 April 2023
                Date revision received : 6 June 2023
                Date accepted : 7 June 2023
                Categories
                Subject: 3300
                Subject: Research Article
                Subject: Clinical Trial/Experimental Study
                Custom metadata
                OPEN-ACCESS TRUE

                Keywords: abdominal binder,ambulation time,laparoscopic surgery,pulmonary recruitment maneuver,shoulder pain
                Data availability:
                Keywords: abdominal binder, ambulation time, laparoscopic surgery, pulmonary recruitment maneuver, shoulder pain

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