Low-pressure pulmonary recruitment maneuver: equal to or worse than moderate-pressure pulmonary recruitment maneuver in preventing postlaparoscopic shoulder pain? A randomized controlled trial of 72 patients

Introduction
The pulmonary recruitment maneuver (PRM) has emerged as an effective way of reducing post-laparoscopic shoulder pain (PLSP). However, the optimal lower pressure level for a PRM to reduce PLSP has not yet been investigated.

Aim
To compare the efficacy of the low-pressure PRM with moderate-pressure PRM in preventing PLSP.

Material and methods
Seventy-two ASA I–II patients who were scheduled for gynecologic LS for non-malignant conditions were enrolled in this study. Group 1 included patients who received the PRM at a maximum pressure of 30–40 cm H₂O in a semi-Fowler position and group 2 included patients who received the PRM at a maximum pressure of 15 cm H₂O in a semi-Fowler position. The primary outcome of the study was the difference in PLSP between the two groups.

Results
There were no significant differences in PLSP and wound pain VAS scores between patients receiving the PRM at 30 cm H₂O and 15 cm H₂O during postoperative pain monitoring (p < 0.05). The groups were also similar with respect to ambulation time (p = 0.215), length of hospital stay (p = 0.556) and the height of the pneumoperitoneum measured on chest X-ray (p = 0.151).

Conclusions
The low-pressure PRM (15 cm H₂O pressure) provides similar efficacy as the moderate-pressure PRM (30–40 cm H₂O) in terms of PLSP, wound pain, height of pneumoperitoneum, time of ambulation and length of hospital stay. We suggest that lower maximal inspiratory pressure of 15 cm H₂O might be preferred to avoid the potential complications of the PRM with higher pressures.