Effect of the Trendelenburg position, Deep Breathing Exercise, and Warm Water Application on Shoulder Pain and Post-gynecologic Laparoscopic Recovery

Abstract

Background: Shoulder pain is a prevalent complaint after laparoscopic surgery. Non-pharmacological nursing measures reduce pain, and analgesic drug dosage, improve women's emotional control, and increase their functional capability. Aim: This study aimed to investigate the effect of the Trendelenburg position, deep breathing exercise, and warm water application on shoulder pain and post-gynecologic laparoscopic recovery. Design: A quasi-experimental study was conducted in the post-laparoscopic unit at El-Shatby Obstetrics and Gynecology University Hospital, Alexandria, Egypt. Methods: A sample of 90 women were randomly assigned to three groups; women in study groups either placed in Trendelenburg position or instructed to perform deep breathing exercises while the third group received warm water application. Participants rated their shoulder pain and the postoperative quality of recovery at baseline, 12, and 24 hours. Results: A significant decline in the pain score was noticed at 24 hours measurement where, the mean score was 2.70±1.47 in the Trendelenburg position group while it was 3.97±1.83 in deep breathing exercise group and 3.90±1.95 in warm water application group (p<0.001 for each group). The mean score of postoperative quality of recovery was 166.87±9.63 in the Trendelenburg group, 131.27±10.96 in the deep breathing exercise group and 154.70±7.53 in the warm water application group, (P<0.001). Conclusion: The three interventions showed a noticeable decline in PLSP. However, Trendelenburg's position showed a superior effect to the other two measures. Recommendations: The authors suggested the incorporation of the three studied interventions for caring of women suffering from PLSP in order to benefit from all their effects and maximize pain relieve and enhancing postoperative recovery. Being non-pharmacologic, they can also be administered by trained nursing staff and can even be taught to patients and implemented at home.