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首页> 外文期刊>BMC Anesthesiology >Effect of postoperative Trendelenburg position on shoulder pain after gynecological laparoscopic procedures: a randomized clinical trial
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Effect of postoperative Trendelenburg position on shoulder pain after gynecological laparoscopic procedures: a randomized clinical trial

机译：术后Trendenburg位置对妇科腹腔镜手术后肩痛的影响：随机临床试验

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Laparoscopic surgery has become a standard of care for many gynecological surgeries due to its lower morbidity, pain and cost compared to open techniques. Unfortunately, the use of carbon dioxide (CO2) to insufflate the abdomen is the main contributor to post-operative shoulder pain. We aim to assess the effect of postoperative Trendelenburg position on shoulder pain after gynecological laparoscopic procedures. We hypothesize that maintaining the patient in Trendelenburg for 24?h postoperatively will significantly decrease postoperative shoulder pain and analgesic consumption. After obtaining written informed consent, 108 patients were prospectively randomized into two groups. In the control group, patients underwent standard gynecologic laparoscopic procedures; then after passive deflation of the pneumoperitoneum at the end of the surgery, the patients were placed in supine head up position in the post anesthesia care unit (PACU) and received our institution’s common postoperative care. Patients in the intervention group were subjected to the same maneuver but were positioned in a Trendelenburg position (20 °) once fully awake and cooperative in the PACU and retained this position for the first 24?h. Numerical rating scale (NRS) was used to assess shoulder pain and nausea upon patient arrival to the PACU, at 4, 6, 12 (primary outcome) and 24?h postoperatively. Time to first rescue pain medication, total rescue pain medications and overall satisfaction with pain control were recorded. 101 patients were included in the final data analysis. Both groups were comparable in terms of baseline characteristics. NRS pain scores were significantly lower in the intervention group at 12?h compared to the control group (0 [0–1] versus 5 [1–4], p??0.001), furthermore improvement in postoperative shoulder pain between time of arrival to PACU (time zero) and 12?h postoperatively was significantly higher in patients allocated to the experimental group compared to the control group. Pain scores were significantly lower in patients allocated to the experimental group versus the control group (0 [0–1] versus 5 [1–4], p??0.001). In conclusion, Trendelenburg position is an easy non-pharmacologic intervention that is beneficial in reducing postoperative shoulder pain following gynecologic laparoscopic surgery.
机译：由于其与开放技术相比，由于其较低的发病率，疼痛和成本，腹腔镜手术已成为许多妇科手术的标准。不幸的是，使用二氧化碳（CO2）将腹部吹入腹部是术后肩部疼痛的主要因素。我们的目标是在妇科腹腔镜手术后评估术后Trendenburg地位对肩痛的影响。我们假设术后将患者维持在Trendelenburg术后24次，将显着降低术后肩痛和镇痛药。获取书面知情同意后，108名患者潜在一时被随机分为两组。在对照组中，患者接受了标准的妇科腹腔镜手术;然后在手术结束时肺炎骨酮的被动通气后，患者置于麻醉后护理单元（PACU）中仰卧位上位，并获得了我们机构的常见术后护理。干预组中的患者进行了相同的机动，但在普通话（20°）中曾经在PACU中完全清醒并合作，并保留了第一个24次的职位。数值评级规模（NRS）用于评估患者到达PACU的肩痛和恶心，术后4,6,12（初级结果）和24μl。记录了首次拯救止痛药的时间，记录了总救援疼痛药物和疼痛对照的总体满意度。 101名患者被列入最终数据分析中。两组在基线特征方面是可比的。与对照组相比，在12μl的干预组中，NRS疼痛评分在12℃（0 [0-1]与5 [1-4]，p≤0.001），进一步改善了术后肩痛与对照组分配给实验组的患者术后抵达PACU（时间零）和12？h术后显着高。分配给实验组的患者与对照组（0 [0-1]与5 [1-4]，p≤0.001），疼痛评分显着降低。总之，Trendelenburg的位置是一种简单的非药理学干预，有利于在妇科腹腔镜手术后减少术后肩痛。

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