BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSION In conclusion, Trendelenburg position is an easy non-pharmacologic intervention that is beneficial in reducing postoperative shoulder pain following gynecologic laparoscopic surgery. TRIAL REGISTRATION Retrospectively registered at Clinicaltrials.gov, registration number NCT04129385, date of registration: June 28, 2019.

中文翻译：

---

术后特伦德伦伯卧位对妇科腹腔镜手术后肩部疼痛的影响：一项随机临床试验。


背景技术由于与开放技术相比，腹腔镜手术的发病率、疼痛和成本较低，因此已成为许多妇科手术的护理标准。不幸的是，使用二氧化碳 (CO2) 向腹部充气是导致术后肩部疼痛的主要原因。方法 我们的目的是评估术后特伦德伦伯卧位对妇科腹腔镜手术后肩部疼痛的影响。我们假设术后将患者保持在特伦德伦伯卧位 24 小时将显着减少术后肩部疼痛和镇痛药消耗。在获得书面知情同意书后，108 名患者被前瞻性随机分为两组。对照组患者接受标准妇科腹腔镜手术；手术结束后对气腹进行被动放气后，将患者置于麻醉后监护病房（PACU）中，以仰卧位头颅抬高位，接受我院常规术后护理。干预组中的患者接受相同的操作，但一旦完全清醒并在 PACU 中配合，则处于特伦德伦堡位置 (20°)，并在前 24 小时内保持该位置。使用数字评定量表 (NRS) 评估患者到达 PACU 后、术后 4、6、12（主要结果）和 24 小时的肩部疼痛和恶心情况。记录首次抢救止痛药物的时间、总抢救止痛药物的时间以及对疼痛控制的总体满意度。 101 名患者纳入最终数据分析。结果 两组的基线特征具有可比性。与对照组相比，干预组 12 小时时的 NRS 疼痛评分显着较低（0 [0-1] 比 5 [1-4]，p < 0。001），此外，与对照组相比，分配到实验组的患者在到达 PACU 时间（零时间）和术后 12 小时之间术后肩部疼痛的改善明显更高。分配到实验组的患者的疼痛评分显着低于对照组（0 [0-1] vs 5 [1-4]，p < 0.001）。结论 总之，特伦德伦伯卧位是一种简单的非药物干预措施，有利于减轻妇科腹腔镜手术后的肩部疼痛。试验注册在ClinicalTrials.gov上追溯注册，注册号NCT04129385，注册日期：2019年6月28日。