eISSN: 2299-0054
ISSN: 1895-4588
Videosurgery and Other Miniinvasive Techniques
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4/2019
vol. 14
 
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abstract:
Original paper

Semi-Fowler positioning in addition to the pulmonary recruitment manoeuvre reduces shoulder pain following gynaecologic laparoscopic surgery

Huseyin Kiyak
1
,
Gulseren Yilmaz
2
,
Necmiye Ay
2

  1. Department of Obstetrics and Gynecology, Istanbul Kanuni Sultan Suleyman Teaching and Research Hospital, Health Sciences University, Istanbul, Turkey
  2. Department of Anesthesiology and Reanimation, Istanbul Kanuni Sultan Suleyman Teaching and Research Hospital, Health Sciences University, Istanbul, Turkey
Videosurgery Miniinv 2019; 14 (4): 567–574
Online publish date: 2019/04/11
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Introduction
The semi-Fowler position, defined as a body position at 30 head-of-bed elevation, has been shown to increase intra-abdominal pressure.

Aim
To investigate the impact of semi-Fowler positioning in addition to the pulmonary recruitment manoeuvre (PRM) on post-laparoscopic shoulder pain.

Material and methods
One hundred and six patients (mean age: 43 ±12 years) undergoing gynaecologic laparoscopic surgery (LS) were included. The patients were divided into three groups: group 1 consisted of patients receiving PRM in the neutral position, group 2 comprised patients receiving PRM in the semi-Fowler position, and patients in the control group received neither PRM nor additional positioning. Information concerning wound and shoulder pain (post-laparoscopic shoulder pain – PLSP) at postoperative 6, 12 and 24 h was recorded using a visual analogue scale (VAS) for each patient.

Results
The PLSP scores at postoperative 6 h (5.71 ±0.86, 5.28 ±0.84 and 6.61 ±0.91, respectively, p < 0.001), 12 h (4.41 ±0.83, 4.01 ±0.82 and 5.32 ±0.97, respectively, p < 0.001), and 24 h (3.24 ±0.78, 2.44 ±0.73 and 4.34 ±0.85, respectively, p < 0.001) were significantly different among the groups, the lowest being in those who received PRM in addition to semi-Fowler positioning.

Conclusions
Semi-Fowler positioning in addition to PRM significantly reduces post-laparoscopic shoulder pain. We assume that the benefit gained using the semi-Fowler positioning is mainly derived from its potential to better evacuate the remaining abdominal gas following LS.

keywords:

semi-Fowler positioning, pulmonary recruitment manoeuvre, shoulder pain, laparoscopy

  
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