الفهرس 
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Abstract
Although the pain following laparoscopic surgery is usually milder and easier to resolve than that after a laparotomy, shoulder pain is a very common presentation that may cause even more discomfort than the pain at the incision site. Thus, several trials have assessed the use of intraperitoneal local anesthetics with controversial results that reported that a pulmonary recruitment maneuver that removed residual abdominal CO2 after laparoscopy reduced shoulder pain by more than half.
The purpose of this randomized controlled trial was to compare the effectiveness of intraperitoneal bupivacaine and intraperitoneal dexamethasone if used alone and if used with combination by pulmonary recruitment maneuver.
The study included 36 patients admitted for Elective laparoscopic cholecystectomy under general anesthesia, patients were randomly allocated to either intraperitoneal bupivacaine (sunny Marcaine) 50 ml 0.25% (125 mg) + intraperitoneal dexamethasone 16 mg (GROUP-A) or intraperitoneal bupivacaine (sunny Marcaine) 50 ml 0.25% (125 mg) + intraperitoneal dexamethasone 16 mg with lung recruitment (GROUP-B).
Patients in both groups were matched regarding their demographic and basic clinical data. A slight but significant (p = 0.03) difference was found in the duration of surgery between the two groups.
According to VAS assessment, post-operative shoulder pain score was significantly lower in group-B compared with group-A (4.00 ±0.686 vs. 4.17, p=0.001), while for abdominal and incision pain; VAS score showed non-statistically significant difference between both groups.
Compared with the control group, the combination therapy group showed that the VAS scores for shoulder pain tended to gradually decrease at any of the postoperative time intervals, the most significant decrease in shoulder pain at 12 and 24 hours postoperatively.
It is concluded that, intraperitoneal instillation of bupivacaine provides good analgesia in the postoperative period after laparoscopic cholecystectomy. The current study showed that performing a pulmonary recruitment maneuver at the completion of laparoscopic surgery further significantly reduces shoulder pain after cholecystectomy laparoscopy.