Low-pressure Pulmonary Recruitment Maneuver to Decrease Post-laparoscopic Shoulder Pain in Gynecologic Surgery

Research design is Randomized control trial. The women who go to laparoscopic gynecologic surgery don't know the allocation. Women will be randomizes in to 3 group: PRM 30 cmH2O, 40 cmH2O and control

After laparoscopic surgery has finished in operator room (before moving off trocar), woman all group will be set in Trenderlenberg position (Tilted head low) and then surgeon will compress abdomen to release residual gas after operation about 2 minutes.

The patients in group of using Pulmonary Recruitment Maneuver will be received positive pressure from balloon bag from anesthesiologist 5 times of setting pressure [30 cmH2O, 40 cmH2O], 5 seconds per time to increase indirect abdominal pressure to release residual gas

After surgery at 12, 24 and 48 hours, patients will be follow up and evaluate shoulder and wound pain. Chest X-ray will be done to evaluate residual pneumoperitoneum and lung complication. GI discomfort, administered additional analgesics and time to hospital staying will be evaluated and recorded.

Inclusion criteria

• Age between 18 and 65 years
• Anesthesiologists physical status (ASAPS) classification I-II
• Absence of Pregnancy
• With inform-consent

Exclusion criteria

• Inability to accurately express pain
• Past history of shoulder or lung surgery
• Chronic shoulder problem
• Epigastric pain
• Lung disease such as emphysema or pneumothorax
• Severe kidney or liver disease
• Drug allergy (NSAIDs, Paracetamol)
• On current medication: corticosteroid
• Psychiatric disorder