Analgesic Effect of Pulmonary Recruitment and Intraperitoneal Hydrocortisone in Laparoscopic Gynecological Surgery
Analgesic Effect of Pulmonary Recruitment and Intraperitoneal Hydrocortisone in Laparoscopic Gynecological Surgery
The aim of this study is to compare the postoperative analgesic efficacy of intraperitoneal
 hydrocortisone to pulmonary recruitment maneuver in Laparoscopic gynaecological surgery.
Laparoscopic surgeries are becoming more attractive because of an early recovery . However,
 post laparoscopic shoulder and upper abdominal pain may cause more discomfort to the patient
 than the pain at the incision site.

 Proper pain relief is a major concern and area of focus. Pre-operatively, one of the most
 common questions asked by patients about the amount of pain they will experience after the
 surgery. Pain has been found to be one of the three most common medical causes of delayed
 discharge after ambulatory surgery, the other two being drowsiness and nausea and vomiting.
 Unfortunately prevention and treatment of postoperative pain continues to be a major
 challenge in postoperative care.

 Good pain control after surgery is important to prevent negative outcomes such as
 tachycardia, hypertension, myocardial ischemia, decrease in alveolar ventilation, and poor
 wound healing.

 Pain also can prolong hospital stay, which is particularly important in day case procedures.

 The mechanism of laparoscopy induced shoulder pain is mainly derived from carbon dioxide
 retention within the abdomen, subsequently irritating the phrenic nerve and causing referred
 pain in the C4 dermatome. Moreover, carbon dioxide trapped between the liver and the right
 diaphragm, irritating the diaphragm, also causes upper abdominal pain.

 Although there are many analgesic drugs available for postoperative pain, many patients still
 find them to be suboptimal for controlling pain.

 Many strategies, including treatment with non steroidal anti-inflammatory drugs, have been
 used to try to reduce laparoscopy-induced shoulder pain however, no sufficiently reliable
 methods have been reported yet .

 Also Intraperitoneal local anesthetic was tried as an important addition for postoperative
 pain in the era of modern surgery. The method of delivering local anesthetic directly to the
 intraperitoneal cavity was first described in 1951 by Griffin et al. ; however, this method
 was forgotten for many years until its implementation in minimal access surgery was
 reappeared. It significantly reduces postoperative pain and opioid consumption after
 laparoscopic gynecological and general surgical operations.

 Another effective method is the pulmonary recruitment maneuver (PRM) which can mechanically
 remove residual carbon dioxide and therefore decreasing peritoneal irritation, and shoulder
 pain.

 Intravenous steroids have been used successfully for postoperative pain relief in different
 kinds of surgery . Also intraperitoneal hydrocortisone was has been used effectively to
 reduce pain after laparoscopic cholecystectomy.

 In addition combination of intraperitoneal local anesthetics with hydrocortisone was proved
 to be a successful method in controlling upper abdominal and shoulder pain after laparoscopic
 procedures.
Inclusion Criteria:

 -  • female gender, age 20-45 years undergoing laparoscopic gynecological operations

 -  American Society of Anesthesiologist physical status classification of I or II

 Exclusion Criteria:

 -  • Patients younger than 20 years or older than 45 years

 -  History of chronic pain

 -  Regular medication with analgesics, or steroids

 -  Analgesic use within 24 h of surgery ,drug or alcohol abuse

 -  Associated chronic diseases like diabetes mellitus, pulmonary diseases ,poor
 cardiac reserve,hepatorenal insufficiency.