Gynecologic Disease, Post Operative Pain, Shoulder Pain
Conditions
Keywords
Modified Trendelenburg, Shoulder Pain, Laparoscopic hysterectomy
Brief summary
Laparoscopic surgery is commonly used procedure in diagnostic and treatment including Hysterectomy. Post laparoscopic shoulder pain is common side effect mostly occur after surgery. Postoperative Trendelenburg position might decrease pain by reducing the mechanical pressure of CO2 on the diaphragm. Maintaining the patient in Trendelenburg for 6 hours postoperatively will decrease postoperative shoulder pain.
Detailed description
After laparoscopic hysterectomy surgery, Patients in intervention group were positioned in a Modified Trendelenburg position (20 °) postoperative for 6 hours because of the limitation of this study cannot positioned in Trendelenburg position. A modified Trendelenburg position is head and trunk of patient were in neutral position while hips and lower extrimities were raised at 20 degree. In control group were in neutral position. All patients were asked shoulder pain score at ward, 6 , 12, 24 hours after postoperative Modified Trendelenburg position for 6 hours
Interventions
PROCEDUREPostoperative Modified Trendelenburg position
Patients underwent the laparoscopic hysterectomy were positioned in a Modified Trendelenburg position (20 °) postoperative for 6 hours at ward.
Sponsors
Department of Medical Services Ministry of Public Health of Thailand
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
30 Years to 65 Years
Healthy volunteers
Yes
Inclusion criteria
* Female patient age between 30-65 years * American Society of Anesthesiologist (ASA) physical status I or II * Scheduled for operative laparoscopic hysterectomy with abdominal incisions measuring less than 1 cm in size * Can speak and understand Thai language
Exclusion criteria
* Pregnant women * Conversion procedure to open abdominal surgery * Patients with postoperative abdominal drainage * Surgery duration more than 3 hours * Gynecologic malignancy surgery * Patients with history of chronic shoulder pain * Patients with history of previous shoulder surgery * Inability to accurately express pain * Patients with history of Gastroesophageal reflux disease or chronic gastritis * Patients with history of cardiovascular or pulmonary disease * Patients with history of venous thrombosis * Morbid obesity BMI \> 40 kg/m2 * Patients with history of increase intracranial pressure * Patients with history of increase intraocular pressure * Patients with liver and/or kidney disease * NSAIDs and/or Paracetamol and/or Morphine allergy * Current corticosteroid use * Patients who use current analgesic drugs and don't want to quit while stay in the hospital * Psychiatric disorder * Intellectual disorder * Postoperative length in hospital less than 24 hours
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Comparison of shoulder pain score | at ward, 6 , 12, 24 hours after postoperative Modified Trendelenburg position for 6 hours | Comparison of shoulder pain score at 6 hours after postoperative Modified Trendelenburg position for 6 hours Using Numerical rating scale 0-10, 0 mean no pain, 10 mean worst pain |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Comparison of nausea vomiting score | at ward, 6 , 12, 24 hours after postoperative Modified Trendelenburg position for 6 hours | Comparison of nausea vomiting score at ward, 6 , 12, 24 hours after postoperative Modified Trendelenburg position for 6 hours Nausea vomiting score grading : 1. None mean no symptom, 2. Mild mean only nausea, not required antiemetic drugs 3.Moderate mean have symptom of nausea and vomiting and required antiemetic drugs 4.Severe mean have symptom of nausea and vomiting and required antiemetic drugs more than 1 time |
| Total amount of antiemetic drugs in 24 hours postoperatively | 24 hours postoperatively | Total amount of antiemetic drugs in 24 hours postoperatively |
| Comparison of upper abdominal pain score | at ward, 6 , 12, 24 hours after postoperative Modified Trendelenburg position for 6 hours | Comparison of upper abdominal pain score at ward, 6 , 12, 24 hours after postoperative Modified Trendelenburg position for 6 hours Using Numerical rating scale 0-10, 0 mean no pain, 10 mean worst pain |
| Comparison of lower abdominal pain score | at ward, 6 , 12, 24 hours after postoperative Modified Trendelenburg position for 6 hours | Comparison of lower abdominal pain score at ward, 6 , 12, 24 hours after postoperative Modified Trendelenburg position for 6 hours Using Numerical rating scale 0-10, 0 mean no pain, 10 mean worst pain |
Countries
Thailand
Outcome results
None listed