Date of this Version


Document Type

DNP Project


Background: Post-laparoscopic shoulder pain occurs in up to 80% of patients undergoing laparoscopic abdominal and/or pelvic surgery and is not as responsive to analgesics as wound pain is. Therefore, prevention is a more effective management technique for this type of pain. Pulmonary recruitment maneuvers (PRM) have shown some benefit in reducing post-laparoscopic shoulder pain (PLSP).

Objectives: The systematic review aimed to assess the best present randomized-controlled trials (RCTs) and meta-analysis regarding the efficacy of PRM to decrease PLSP. The education module aimed to inform anesthesia providers of the benefits of PRMs in the management of PLSP.

Data Sources: Investigators used CINAHL, MedLine, and EMBASE databases to answer the PICO question: (P) In patients undergoing laparoscopic surgery, does utilizing (I) pulmonary recruitment maneuvers compared to (C) manual abdominal compression to remove residual CO2 upon trocar removal decrease (O) postoperative shoulder pain intensity?. Data from the pre- and post-test surveys in the education module were collected in Qualtrics and exported to SPSS statistical software for analysis.

Methodology: Ten RCTs and meta-analysis of RCTs were included in this systematic review. The combined sample size was 2,264 patients, and these studies found patients who received PRM to have superior PLSP management. This information was incorporated into an education module. Anesco provided an email list of CRNAs. These CRNAs were emailed an anonymous link to the education module containing a pre- and post-test along with a voiced-over PowerPoint video.

Results: Statistical analysis via SPSS showed that the average on the post-test increased from the pre-test with a p-value of 0.423, indicating a lack of statistical significance of these results. There was an increase in the likelihood of CRNAs to recommend the use of PRMs after viewing the education module.

Conclusions: The empirical evidence shows that PRM provides a reduction in post-laparoscopic shoulder pain scores. Implementing an evidence-based PRM project can lead to positive patient outcomes and potential increased patient satisfaction, and reduced opioid consumption. Lastly, CRNA providers benefit from an educational module presenting current evidence-based information on the newest PLSP management techniques. The knowledge increase also led to providers being more likely to recommend PRMs to reduce PLSP.