OBJECTIVE: This study investigated whether intraoperative controlled hyperventilation could reduce the incidence and severity of post-laparoscopic shoulder pain. METHODS: In this prospective, randomized, double-blind controlled trial, 150 patients undergoing elective laparoscopic cholecystectomy were randomly assigned to either controlled hyperventilation (n = 75) or conventional ventilation (n = 75) groups. The hyperventilation group received mechanical ventilation with a tidal volume of 10 mL/kg and respiratory rate adjusted to maintain end-tidal CO RESULTS: The hyperventilation group demonstrated significantly lower shoulder pain incidence (36.0% vs. 60.0%, P = 0.003), shorter pain duration (4.13 ± 6.25 vs. 9.24 ± 7.82 h, P <
0.001), and consistently lower pain intensity scores at all time points up to 48 h postoperatively. The intervention group also showed shorter operation time (50.01 ± 12.04 vs. 80.32 ± 34.23 min, P <
0.001), lower pneumoperitoneum pressure requirements (11.73 ± 1.19 vs. 33.72 ± 19.47 mmHg, P <
0.001), and improved patient satisfaction (73.33% vs. 42.67%, P <
0.001). No significant differences were observed in postoperative complications, time to first flatus, or length of hospital stay. CONCLUSION: Intraoperative controlled hyperventilation effectively reduces the incidence and severity of shoulder pain following laparoscopic cholecystectomy, while improving surgical conditions and patient satisfaction. This simple intervention provides a safe and cost-effective approach to enhancing postoperative outcomes in laparoscopic surgery.