Ventilation strategies and postoperative pain in laparoscopic cholecystectomy: pulmonary recruitment maneuver versus extended hyperventilation: a prospective randomized study

Objectives: Acidic milieu created by carbon dioxide is associated with post laparoscopic surgical pain. Gas washing techniques were used to reduce such effects. This trial compared pulmonary recruitment maneuver (PRM) versus extended hyperventilation technique (EHV) regarding postoperative pain profile in laparoscopic cholecystectomy patients.

Methods: In a prospective, randomized controlled study, 90 patients, underwent laparoscopic cholecystectomy were divided into two equal groups; (PRM group) and (EHV group). Collected data included heart rate (HR), mean arterial blood pressure (MAP), visual analog score (VAS), the incidence of shoulder and sub-diaphragmatic pain, postoperative nausea, and vomiting (PONV).

Results: The overall incidence of shoulder and sub-diaphragmatic pain, late VAS score (at 12, 24 hours) were lower in the EHV group, while hemodynamics, early VAS scores, rescue analgesic consumption, and PONV were comparable in both groups. Conclusion: Gas washing techniques improved safety and efficacy in improving pain profile following laparoscopic surgery. EHV provides less pain and more patients comfort than PRM, especially at delayed times.

Laparoscopic surgery; Pain; VAS score; Hyperventilation; Recruitment maneuver

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