The Effect of Postoperative Modified Trendelenburg Position to Decrease Shoulder Pain After Laparoscopic Hysterectomy: A Randomized Controlled Trial

The Effect of Postoperative Modified Trendelenburg Position to Decrease Shoulder Pain After Laparoscopic Hysterectomy: A Randomized Controlled Trial

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.

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

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