Investigating the effects of drainage by hemovac drain on shoulder pain after female laparoscopic surgery and comparison with deep breathing technique: a randomized clinical trial study

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The incidence of shoulder pain following laparoscopic surgery has been reported to be high. This study was designed to investigate the effect of Hemovac drain on postoperative pain of women after laparoscopic surgery, dose of postoperative drug, duration of hospitalization as well as comparison with deep breathing technique.


In this clinical trial, one hundred and fourteen female patients treated by laparoscopy were randomly assigned to three groups of 38 patients. In our study group, the Hemovac drain was implemented from the secondary trocar site with a closed system. In the deep breathing group, the patient was asked to breathe slowly and deeply three time per hour at full vigilance after surgery. In the non-drain group, laparoscopic surgery was done routinely. The severity of abdominal and shoulder pain was measured with a visual scale of pain at 3, 6, 12, and 24 h after surgery.


There were no significant differences in age, type of surgery, duration of hospitalization, postoperative nausea and vomiting between the groups after surgery. The severity of shoulder pain was significant between groups 3, 6, 12, and 24 h after surgery (p < 0.001). Consumption of diclofenac after operation was higher in the control group (p < 0.001). The pain level of laparoscopic surgery was not different between the three groups within the first 24 h after surgery (p = 0.841).


The use of Hemovac drain in female laparoscopic surgery is beneficial for reducing the subsequent shoulder pain. Further studies are recommended to investigate the effects of deep breathing as a non-pharmacological and safe method in other laparoscopic areas.

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The authors of this paper would like to thank Urmia University of Medical Sciences due to gathering the data of project No. 3245, which has been approved by Mazandaran University of Medical Sciences as an MSc thesis of Operation Room with ethics code IR.MAZUMS.REC.1397.3245 registered in National system by IRCT20190113042347N1 code.

Author information

Principle investigator: EN, FH; Research conception and design: EN, FH; Data acquisition, FH, TB; Analysis and interpretation of data: EN; Drafting of manuscript: FH, EN, TB; writing and revising of the manuscript: Critical revision: FH, EN, TB; Approval of final manuscript: FH, EN, TB.

Correspondence to Ebrahim Nasiri.

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Miss Fatemeh Hosseinzadeh as a first author, and Dr Ebrahim Nasiri as a corresponding author and Dr Tahereh Behroozi as a surgeon and third author have no conflicts of interest or financial ties to disclose.

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Hosseinzadeh, F., Nasiri, E. & Behroozi, T. Investigating the effects of drainage by hemovac drain on shoulder pain after female laparoscopic surgery and comparison with deep breathing technique: a randomized clinical trial study. Surg Endosc (2020) doi:10.1007/s00464-019-07339-z

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  • Drainage
  • Shoulder pain
  • Laparoscopy
  • Deep breathing
  • Gynecological surgery