Low-pressure pulmonary recruitment maneuver: equal to or worse than moderate-pressure pulmonary recruitment maneuver in preventing postlaparoscopic shoulder pain? A randomized controlled trial of 72 patients

Introduction: The pulmonary recruitment maneuver (PRM) has emerged as an effective way of reducing post-laparoscopic shoulder pain (PLSP). However, the optimal lower pressure level for a PRM to reduce PLSP has not yet been investigated.

Aim: To compare the efficacy of the low-pressure PRM with moderate-pressure PRM in preventing PLSP.

Material and methods: Seventy-two ASA I-II patients who were scheduled for gynecologic LS for non-malignant conditions were enrolled in this study. Group 1 included patients who received the PRM at a maximum pressure of 30-40 cm H₂O in a semi-Fowler position and group 2 included patients who received the PRM at a maximum pressure of 15 cm H₂O in a semi-Fowler position. The primary outcome of the study was the difference in PLSP between the two groups.

Results: There were no significant differences in PLSP and wound pain VAS scores between patients receiving the PRM at 30 cm H₂O and 15 cm H₂O during postoperative pain monitoring (p < 0.05). The groups were also similar with respect to ambulation time (p = 0.215), length of hospital stay (p = 0.556) and the height of the pneumoperitoneum measured on chest X-ray (p = 0.151).

Conclusions: The low-pressure PRM (15 cm H₂O pressure) provides similar efficacy as the moderate-pressure PRM (30-40 cm H₂O) in terms of PLSP, wound pain, height of pneumoperitoneum, time of ambulation and length of hospital stay. We suggest that lower maximal inspiratory pressure of 15 cm H₂O might be preferred to avoid the potential complications of the PRM with higher pressures.