Postoperative analgesic efficacy of the pulmonary recruitment manoeuvre compared to intraperitoneal hydrocortisone in laparoscopic gynaecological surgeries

Abstract

Background and Aims: Laparoscopic surgeries are becoming attractive because of early recovery. Adequate postoperative pain relief may be a major concern. Several methods have been used to relieve laparoscopic postoperative pain. Methodology: This prospective, randomised, controlled study was conducted during the period between February and June 2019. Patients were assigned into three groups. Patients in the hydrocortisone group received intraperitoneal 100mg hydrocortisone in 150 ml normal saline together with the routine method to remove carbondioxide (CO2). For patients in the pulmonary recruitment group, CO 2 was exsufflated by pulmonary recruitment manoeuvre together with the routine method to remove CO 2 . In the control group CO 2 was removed by applying gentle abdominal pressure allowing passive exsufflation through the port site. Results: A total of 57 patients were included in the study. There was no statistically significant difference between the three groups as regards demographic characteristics. There was a statistically significant difference in the 24 h postoperative analgesic consumption (primary outcome) in the hydrocortisone and pulmonary recruitment groups in comparison to the control group:P value <0.001. Also, time to first request for analgesia was significantly longer and the visual analogue scale (VAS) score was significantly lower in the hydrocortisone and pulmonary recruitment groups compared to the control group:P value <0.001. Conclusion: Intraperitoneal hydrocortisone and pulmonary recruitment manoeuvre could both effectively reduce pain after gynaecological laparoscopic surgeries, however, intraperitoneal hydrocortisone might give a longer pain-free time.

Comparison of Intraperitoneal Versus Intravenous Dexamethasone on Postoperative Pain, Nausea, and Vomiting After Laparoscopic Cholecystectomy

“…Sultan et al reported that the preoperative administration of 0.1 mg/kg single-dose IV dexamethasone could enhance the quality of patient recovery and improve pain control after laparoscopic cholecystectomy, compared to lignocaine (23). Additionally, Elsakka et al studied the effect of different corticosteroids on POP and proved that the administration of IP dexamethasone and hydrocortisone could reduce abdominal pain and shoulder pain in patients and consequently reduce the need for the administration of analgesics after laparoscopic chole-cystectomy, without causing any significant side effect to patients (23,24).…”

Use of intraoperative mild hyperventilation to decrease the incidence of postoperative shoulder pain after laparoscopic gastric sleeve surgery: A prospective randomised controlled study

“…[ 12 ] Reduction of physical irritation can be achieved by using gas warming,[ 13 ] low pneumoperitoneal pressures, low gas insufflation rates,[ 14 ] or even use of gasless laparoscopy. [ 15 ] Moreover, other interventions dealt with the pain signal itself by suppressing its initiation using anti-inflammatory medications,[ 16 ] blocking its transmission by applying a local anaesthetic solution to the diaphragmatic surface at the end or beginning of surgery,[ 17 18 19 ] intraperitoneal instillation of additional dexmedetomidine or clonidine along with bupivacaine,[ 20 ] use of intraperitoneal hydrocortisone[ 21 ] or use of intrathecal clonidine. [ 22 ] The use of low-pressure laparoscopy provides a decrease in both physical and chemical irritation inputs and this explains the suggestion by Donatsky et al .…”