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.
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Abbreviations
- ASA:
-
American society of anesthesiologists
- RCT:
-
Randomized controlled trial
- MD:
-
Mean difference
- CI:
-
Confidence interval
- REM:
-
Random-effects model
References
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
Alexander JI (1997) Pain after laparoscopy. Br J Anaesth 79(3):369–378
Madsen MR, Jensen KE (1992) Postoperative pain and nausea after laparoscopic cholecystectomy. Surg Laparosc Endosc 2(4):303–305
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
Kojima Y, Yokota S, Ina H (2004) Shoulder pain after gynaecological laparoscopy caused by arm abduction. Eur J Anaesthesiol 21(7):578–579
Jackson SA, Laurence AS, Hill JC (1996) Does post-laparoscopy pain relate to residual carbon dioxide? Anaesthesia 51(5):485–487
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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.
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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
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DOI: https://doi.org/10.1007/s00464-014-3934-7