Skip to main content
Log in

Pulmonary recruitment maneuver to reduce pain after laparoscopy: a meta-analysis of randomized controlled trials

  • Review
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

We investigated the impact of pulmonary recruitment maneuver in reducing shoulder pain after laparoscopic procedure.

Methods

We conducted a systematic review of the literature using Medline (1966–2014), Scopus (2004–2014), Popline (1974–2014), www.ClinicalTrials.gov (2008–2014), and Google Scholar (2004–2014) along with reference lists of electronically retrieved studies. Statistical meta-analysis was performed using the RevMan 5.1 software.

Results

Six studies were included in the present systematic review, involving 571 patients. Among them, 291 (51 %) were offered a pulmonary recruitment maneuver, and 280 patients (49 %) were treated with conventional evacuation of pneumoperitoneum that included either passive evacuation or gentle pressing of the abdominal walls with the trocar ports open. The introduction of a pulmonary recruitment maneuver significantly decreased postoperative shoulder pain 12 h (435 patients, REM, MD −1.55, 95 % CI −2.01, −1.10), 24 h (435 patients, REM, MD −1.59, 95 % CI −2.00, −1.18), and 48 h post-operatively (335 patients, REM, MD −0.93, 95 % CI −1.37, −0.50). We also identified evidence of a potential beneficial effect in the reduction of postoperative upper abdominal pain. However, discrepancies in the interpretation of abdominal pain among the included studies precluded meta-analysis of this index.

Conclusions

According to the results of our meta-analysis, pulmonary recruitment maneuver seems to be an easily performed, potentially preventive measure of post-laparoscopic shoulder pain. Further research is mandated, however, in the field, because firm results are precluded by the small number of included studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

ASA:

American society of anesthesiologists

RCT:

Randomized controlled trial

MD:

Mean difference

CI:

Confidence interval

REM:

Random-effects model

References

  1. Ruiz-Rabelo JF, Monjero Ares I, Torregrosa-Gallud A, Delgado Plasencia L, Cuesta MA (2006) Fast-track multimodal rehabilitation programs in laparoscopic colorectal surgery. Cirugia Espanola 80(6):361–368

    Article  PubMed  Google Scholar 

  2. Alexander JI (1997) Pain after laparoscopy. Br J Anaesth 79(3):369–378

    Article  CAS  PubMed  Google Scholar 

  3. Madsen MR, Jensen KE (1992) Postoperative pain and nausea after laparoscopic cholecystectomy. Surg Laparosc Endosc 2(4):303–305

    CAS  PubMed  Google Scholar 

  4. Dixon JB, Reuben Y, Halket C, O’Brien PE (2005) Shoulder pain is a common problem following laparoscopic adjustable gastric band surgery. Obes Surg 15(8):1111–1117. doi:10.1381/0960892055002149

    Article  PubMed  Google Scholar 

  5. Kojima Y, Yokota S, Ina H (2004) Shoulder pain after gynaecological laparoscopy caused by arm abduction. Eur J Anaesthesiol 21(7):578–579

    Article  CAS  PubMed  Google Scholar 

  6. Jackson SA, Laurence AS, Hill JC (1996) Does post-laparoscopy pain relate to residual carbon dioxide? Anaesthesia 51(5):485–487

    Article  CAS  PubMed  Google Scholar 

  7. Lepner U, Goroshina J, Samarutel J (2003) Postoperative pain relief after laparoscopic cholecystectomy: a randomised prospective double-blind clinical trial. Scand J Surg 92(2):121–124

    CAS  PubMed  Google Scholar 

  8. Donatsky AM, Bjerrum F, Gogenur I (2013) Intraperitoneal instillation of saline and local anesthesia for prevention of shoulder pain after laparoscopic cholecystectomy: a systematic review. Surg Endosc 27(7):2283–2292. doi:10.1007/s00464-012-2760-z

    Article  PubMed  Google Scholar 

  9. Donatsky AM, Bjerrum F, Gogenur I (2013) Surgical techniques to minimize shoulder pain after laparoscopic cholecystectomy. A systematic review. Surg Endosc 27(7):2275–2282. doi:10.1007/s00464-012-2759-5

    Article  PubMed  Google Scholar 

  10. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 62(10):e1–e34. doi:10.1016/j.jclinepi.2009.06.006

    Article  PubMed  Google Scholar 

  11. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17(1):1–12

    Article  CAS  PubMed  Google Scholar 

  12. DerSimonian R, Kacker R (2007) Random-effects model for meta-analysis of clinical trials: an update. Contemp Clin Trials 28(2):105–114. doi:10.1016/j.cct.2006.04.004

    Article  PubMed  Google Scholar 

  13. Phelps P, Cakmakkaya OS, Apfel CC, Radke OC (2008) A simple clinical maneuver to reduce laparoscopy-induced shoulder pain: a randomized controlled trial. Obstet Gynecol 111(5):1155–1160. doi:10.1097/AOG.0b013e31816e34b4

    Article  PubMed  Google Scholar 

  14. Sharami SH, Sharami MB, Abdollahzadeh M, Keyvan A (2010) Randomised clinical trial of the influence of pulmonary recruitment manoeuvre on reducing shoulder pain after laparoscopy. J Obstet Gynaecol 30(5):505–510. doi:10.3109/01443611003802313

    Article  CAS  PubMed  Google Scholar 

  15. Tsai HW, Chen YJ, Ho CM, Hseu SS, Chao KC, Tsai SK, Wang PH (2011) Maneuvers to decrease laparoscopy-induced shoulder and upper abdominal pain: a randomized controlled study. Arch Surg 146(12):1360–1366. doi:10.1001/archsurg.2011.597

    Article  PubMed  Google Scholar 

  16. Khanna A, Sezen E, Barlow A, Rayt H, Finch JG (2013) Randomized clinical trial of a simple pulmonary recruitment manoeuvre to reduce pain after laparoscopy. Br J Surg 100(10):1290–1294. doi:10.1002/bjs.9202

    Article  CAS  PubMed  Google Scholar 

  17. Tsai HW, Wang PH, Yen MS, Chao KC, Hsu TF, Chen YJ (2013) Prevention of postlaparoscopic shoulder and upper abdominal pain: a randomized controlled trial. Obstet Gynecol 121(3):526–531. doi:10.1097/AOG.0b013e318283fcca

    Article  PubMed  Google Scholar 

  18. Liu H, Ma C, Zhang X, Yu C, Yang Y, Song X, Tang Y, Guo X (2014) Combined incisional ropivacaine infiltration and pulmonary recruitment manoeuvre for postoperative pain relief after diagnostic hysteroscopy and laparoscopy. Chin Med J 127(5):825–829

    CAS  PubMed  Google Scholar 

  19. Esmat ME, Elsebae MM, Nasr MM, Elsebaie SB (2006) Combined low pressure pneumoperitoneum and intraperitoneal infusion of normal saline for reducing shoulder tip pain following laparoscopic cholecystectomy. World J Surg 30(11):1969–1973. doi:10.1007/s00268-005-0752-z

    Article  PubMed  Google Scholar 

  20. Atak I, Ozbagriacik M, Akinci OF, Bildik N, Subasi IE, Ozdemir M, Ayta NI (2011) Active gas aspiration to reduce pain after laparoscopic cholecystectomy. Surg Laparosc Endosc Percutaneous Tech 21(2):98–100. doi:10.1097/SLE.0b013e318213c301

    Article  Google Scholar 

  21. Radosa JC, Radosa MP, Mavrova R, Rody A, Juhasz-Boss I, Bardens D, Brun K, Solomayer EF, Baum S (2013) Five minutes of extended assisted ventilation with an open umbilical trocar valve significantly reduces postoperative abdominal and shoulder pain in patients undergoing laparoscopic hysterectomy. Eur J Obstet Gynecol Reprod Biol 171(1):122–127. doi:10.1016/j.ejogrb.2013.08.014

    Article  PubMed  Google Scholar 

  22. Radke OC, Phelps P, Cakmakkaya OS, Apfel CC (2008) A simple clinical maneuver to reduce laparoscopy induced shoulder pain: a randomized clinical trial. Anestezjologia i Ratownictwo 111:1155–1160

    Google Scholar 

  23. Cakmakkaya OS, Phelps P, Apfel CC, Radke OC, Korttila K (2008) A simple clinical maneuver to reduce laparoscopy induced shoulder pain: a randomized clinical trial. Eur J Anaesthesiol 25:21

    Article  Google Scholar 

  24. Loizides S, Gurusamy KS, Nagendran M, Rossi M, Guerrini GP, Davidson BR (2014) Wound infiltration with local anaesthetic agents for laparoscopic cholecystectomy. Cochrane Database Syst Rev 3:CD007049. doi:10.1002/14651858.CD007049.pub2

    PubMed  Google Scholar 

  25. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schunemann HJ (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336(7650):924–926. doi:10.1136/bmj.39489.470347.AD

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Disclosures

Vasilios Pergialiotis, Dimitrios-Efthymios G. Vlachos, Kostantinos Kontzoglou, Despina Perrea, and Georgios D. Vlachos have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Vasilios Pergialiotis.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pergialiotis, V., Vlachos, DE.G., Kontzoglou, K. et al. Pulmonary recruitment maneuver to reduce pain after laparoscopy: a meta-analysis of randomized controlled trials. Surg Endosc 29, 2101–2108 (2015). https://doi.org/10.1007/s00464-014-3934-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-014-3934-7

Keywords

Navigation