Laparoscopic procedures are very common and have several benefits over traditional surgical operations with larger incisions (laparotomy). Benefits include but are not limited to lower cost, better pain control, and less risk of complications (Zeeni et. al, 2020). Zeeni et. al (2020) discuss that it is generally thought that use of carbon dioxide gas during laparoscopic procedures is likely the contributing factor in referred shoulder pain after laparoscopic procedures.
Referred shoulder pain can be severe for some patients and is present in 35-70% of patients after these procedures (Zeeni et. al, 2020). Use of extended time in the Trendelenburg position (15-30 degree incline of feet above head in supine position) for assistance in pain control has been shown to be a statistically significant intervention. In Zeeni et. al’s (2020) randomized controlled study, there was improved control of referred shoulder pain at 12 hours post-operatively in the experimental group in which Trendelenburg positioning was implemented for 24 hours after laparoscopic procedures (p < 0.001). The study also demonstrated less need for pain medication (p< 0.001), and generally better patient satisfaction (p<0.001) (Zeeni et. al, 2020).
The use of Trendelenburg positioning is an intervention that any recovery room nurse could initiate if the patient is stable and cooperative. This literature could be discussed as a part of skills days presentations or brought to Magnet committees in facilities with Magnet recognition. This technique is free for the patient and is a quick intervention to utilize when a PACU RN is trying to maintain efficiency while caring for more than one patient in pain. This study could be displayed in areas such as peg boards where evidence-based practice is allowed to be displayed. If patients require less narcotics and have less issues with pain control and post-operative nausea and vomiting, this could potentially help to enhance their overall recovery.
Zeeni, C., Chamsy, D., Khalil, A., Abu Musa, A., Hassanieh, M., Shebbo, F., & Nassif, J. (2020). Effect of postoperative Trendelenburg position on shoulder pain after gynecological laparoscopic procedures: a randomized clinical trial. BMC Anesthesiology, 20(1), 1-7. Retrieved from https://doi-org.ezproxy.fhsu.edu/10.1186/s12871-020-0946-9
You are correct, Laparoscopic procedures are very common and have more benefits than a traditional operation with a larger incision. When I talked to my OB/GYN about tubal ligation. I was discouraged when she explained the procedure. I didn’t like the use of carbon dioxide gas that will be used but I am glad that I went ahead with the procedure because the risk is minimal compared to a traditional operation that poses more risk for infection.
While I think that any resources we have to reduce pain post operative without the use of pain medications looking at the reason for the pain in the first place, which is the introduction of the air into the abdomen in the first place. Chaichian, S., Moazzami, B., Haghgoo, A., & Sheibani, K. (2018) looked at removing the air that was placed in the abd cavity in the first place and how it reduced the pain level of the patients post op. While the idea of trendeleburg is a good one do you feel like the removal of the extra gas once the procedure is completed would also decrease the pain, particularly that of shoulder pain because we are removing the root cause?
Chaichian, S., Moazzami, B., Haghgoo, A., & Sheibani, K. (2018). A New Approach to an Old Concept for Reducing Shoulder Pain Caused by Gynecological Laparoscopy. Journal of Reproduction & Infertility, 19(1), 56–60.
There are studies in the past revealing positive outcomes on pain control in patients undergoing laparoscopic procedures after evacuating CO2 gas. Suginami, Taniguchi, and Suginami (2009) for instance found positive results after using a technique in which they filled the abdomen with saline. It appears that there is not one standard way in which surgeons are currently expelling gas and while some of these studies support your suggestion of removing air, that is not an intervention that can be done by nurses. It would be great for the patient though if the primary intervention for this was done intra-operatively because the sooner the patient able to get up and move around and not be in bed after surgery, the better their outcome will likely be in the prevention of other post-operative complications.
Suginami, R., Taniguchi, F., & Suginami, H. (2009). Prevention of postlaparoscopic shoulder pain by forced evacuation of residual CO(2). JSLS : Journal of the Society of Laparoendoscopic Surgeons, 13(1), 56–59.
Pain after a laparoscopic procedure can sometimes be similar or even more severe than the pain was before surgery. There are many ways to control pain post-op. This article I found talks about what types of pain management should be used for different situations. It talks about using anti-inflammatory medications or corticosteriods for shoulder pain post-op. Do you think that this would help with the gas pain?
Sjövall, S., Kokki, M., & Kokki, H. (2015). Laparoscopic Surgery: A Narrative Review of Pharmacotherapy in Pain Management. Drugs, 75(16), 1867–1889. doi: 10.1007/s40265-015-0482-y