The Effect of Local Anesthesia and Simple Maneuver on Shoulder Pain After Gynecologic Laparoscopy

NCT ID: NCT01039441

Last Updated: 2009-12-25

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

291 participants

Study Classification

INTERVENTIONAL

Study Start Date

2008-12-31

Study Completion Date

2009-07-31

Brief Summary

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This prospective, randomized controlled trial was designed to compare the efficacy of a simple maneuver using lower airway pressure (30 cm H2O) and intraperitoneal instillation of bupivacaine, alone or in combination, to reduce shoulder pain after gynecologic laparoscopy.

Patient aged 15-65 years, scheduled for laparoscopic surgery for benign adnexa disease will be eligible for the study. Patients will be excluded from analysis if the procedure requires conversion to a laparotomy, an operative time \> 3 hours, or interpretation of pain is impossible due to serious adverse effects

240 patients will be randomly assigned to one of four groups Upon completion of surgery, the patient is placed in the Trendelenburg position (30 degrees), and one of four procedures is followed. For group A (control), 50 ml of normal saline is instilled under the diaphragm and CO2 is removed by manual deflation of the abdominal cavity through the cannula; For group B, a mixture of 50ml solution (20ml of 0.5% bupivacaine + 30ml normal saline) is instilled under the diaphragm and CO2 is removed by manual deflation of the abdominal cavity through the cannula; For group C, 50 ml of normal saline is instilled under diaphragm and CO2 was removed by means of a pulmonary recruitment maneuver consisting of five manual inflations of the lung with a maximum pressure of 30 cm H2O. The anesthesiologist holds the fifth positive pressure inflation for approximately 5 seconds. During these maneuvers, the surgeon will be instructed to ensure that the trocar sleeve valve is fully open to allow the CO2 gas to escape. For group D, patients receive an instillation of a mixture of 50ml solution in combination with the clinical maneuver.

Patients will be given a questionnaire with the pain question represented as a visual analog scale (VAS) preoperatively. Patients will be asked to fill out the questionnaires during the first 24 hours after surgery to determine the frequency and severity of their shoulder pain. All patients are instructed to record the pain scores regarding their shoulder pain only. The degree of postoperative shoulder pain will be assessed using VAS at 1, 6, 12, and 24 hours postoperatively. The VAS, with scores ranging from 0 (no pain) to 10 (excruciating pain), is constructed without numeration, thus allowing patients to mark a point along the scale that best represented their pain at that time.

In addition, the following parameters are recorded on the case report form by the investigators: operative time, blood loss, the length of hospital stay, analgesic use, and incidence of postoperative events.

Detailed Description

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Conditions

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Gynecologic Laparoscopic Surgery for Benign Adnexa Disease

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Primary Study Purpose

PREVENTION

Blinding Strategy

DOUBLE

Participants Investigators

Study Groups

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instillation of normal saline 50ml under the diaphragm

Group Type PLACEBO_COMPARATOR

normal saline

Intervention Type OTHER

the instillation of 0.5% bupivacaine under the diaphragm

Group Type EXPERIMENTAL

Intraperitoneal instillation of bupivacaine

Intervention Type PROCEDURE

A mixture of 50ml solution (20ml of 0.5% bupivacaine + 30ml normal saline) is instilled under the diaphragm.

CO2 removal by means of a pulmonary recruitment maneuver

Group Type EXPERIMENTAL

CO2 removal by means of a pulmonary recruitment maneuver

Intervention Type PROCEDURE

CO2 is removed by means of a pulmonary recruitment maneuver consisting of five manual inflations of the lung with a maximum pressure of 30 cm H2O

the instillation of bupivacaine + CO2 removal by maneuver

Group Type EXPERIMENTAL

Intraperitoneal instillation of bupivacaine +CO2 removal by means of a pulmonary recruitment maneuver

Intervention Type PROCEDURE

Interventions

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Intraperitoneal instillation of bupivacaine

A mixture of 50ml solution (20ml of 0.5% bupivacaine + 30ml normal saline) is instilled under the diaphragm.

Intervention Type PROCEDURE

CO2 removal by means of a pulmonary recruitment maneuver

CO2 is removed by means of a pulmonary recruitment maneuver consisting of five manual inflations of the lung with a maximum pressure of 30 cm H2O

Intervention Type PROCEDURE

Intraperitoneal instillation of bupivacaine +CO2 removal by means of a pulmonary recruitment maneuver

Intervention Type PROCEDURE

normal saline

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* benign adnexa diseases which are scheduled for laparoscopic surgery

Exclusion Criteria

* The procedure required conversion to a laparotomy, An operative time \> 3 hours, Interpretation of pain was impossible due to serious adverse effects.
Minimum Eligible Age

15 Years

Maximum Eligible Age

65 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Samsung Medical Center

OTHER

Sponsor Role lead

Responsible Party

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The department of obstetrics and gynecology, Samsung Medical Center

Principal Investigators

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Duk Soo Bae, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Samsung Medical Center

Locations

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Samsung Medical Center

Seoul, , South Korea

Site Status

Countries

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South Korea

References

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Cho M, Kim CJ, Hahm TS, Lee YY, Kim TJ, Lee JW, Kim BG, Bae DS, Choi CH. Combination of a pulmonary recruitment maneuver and intraperitoneal bupivacaine for the reduction of postoperative shoulder pain in gynecologic laparoscopy: a randomized, controlled trial. Obstet Gynecol Sci. 2020 Mar;63(2):187-194. doi: 10.5468/ogs.2020.63.2.187. Epub 2020 Feb 20.

Reference Type DERIVED
PMID: 32206659 (View on PubMed)

Other Identifiers

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2008-07-071

Identifier Type: -

Identifier Source: org_study_id