Pulmonary Recruitment Maneuver for Reducing Shoulder Pain after Laparoscopic Gynecologic Surgery: A Network Meta-Analysis of Randomized Controlled Trials.

Chumnan Kietpeerakool,Marut Yanaranop,Songphol Puttasiri,Siwanon Rattanakanokchai,Ratchadaporn Roekyindee,Aranya Yantapant,Jatupol Srisomboon

doi:10.1155/2020/7154612

Abstract

Background Shoulder pain is a common symptom following laparoscopic surgery. This systematic review was undertaken to assess updated evidence regarding the effectiveness and complications of the pulmonary recruitment maneuver (PRM) for reducing shoulder pain after laparoscopic gynecologic surgery. Methods A number of databases for randomized controlled trials (RCTs) investigating PRM for reducing shoulder pain were searched up to June 2019. Two authors independently selected potentially relevant RCTs, extracted data, assessed risk of bias, and compared results. Network meta-analyses were employed to simultaneously compare multiple interventions. Effect measures were presented as pooled mean difference (MD) or risk ratio (RR) with corresponding 95% confidence intervals (CI). Results Of the 44 records that we identified as a result of the search (excluding duplicates), eleven RCTs involving 1111 participants were included. Three studies had an unclear risk of selection bias. PRM with a maximum pressure of 40 cm H2O was most likely to result in the lowest shoulder pain intensity at 24 hours (MD −1.91; 95% CI −2.06 to −1.76) while PRM with a maximum pressure of 40 cm H2O plus intraperitoneal saline (IPS) appeared to be the most efficient at 48 hours (MD −2.09; 95% CI −2.97 to −1.21). The estimated RRs for analgesia requirement, nausea/vomiting, and cardiopulmonary events were similar across the competing interventions. Conclusion PRM with 40 cm H2O performed either alone or accompanied by IPS is a promising intervention for alleviating shoulder pain within 48 hours following gynecologic laparoscopy.

Highlights

Shoulder pain is a common symptom following laparoscopic gynecologic surgery
To identify potential eligible studies, a systematic literature search was conducted in the major electronic databases including MEDLINE, PubMed, Scopus, ISI Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, and LILACS from their inception to June 2019 (Supplement Table S1). e titles of all relevant articles were identified on Google Scholar, and a further search related to these studies was performed focusing on the first 50 records identified [6]. e World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov, to identify ongoing trials, were searched
Participants undergoing pulmonary recruitment maneuver (PRM) at a maximum inspiratory pressure of 60 cm H2O experienced a slightly higher shoulder pain than those who underwent PRM performed with a maximum inspiratory pressure of 40 cm H2O (MD 0.42; 95% confidence intervals (CI) 0.21 to 0.63) (Table 1). e surface under the cumulative ranking area (SUCRA) rankings indicated that PRM with a maximum inspiratory pressure of 40 cm H2O was most likely to result in the lowest shoulder pain intensity at 24 hours while abdominal compression seemed appreciably less attractive than the other alternatives (Table 2 and Supplement Figure S2)

Summary

Introduction

Shoulder pain is a common symptom following laparoscopic gynecologic surgery. Residual carbon dioxide (CO2) trapped between the liver and the right diaphragm is believed to be an irritation of the diaphragm, leading to referred C4 dermatomal shoulder pain [1] Another possible pathophysiology of shoulder pain after laparoscopic surgery is that intraperitoneal carbonic acid derived from residual CO2 may induce irritation to the phrenic nerve. Effective intervention for reducing shoulder pain following laparoscopic surgery, is mandatory. Is systematic review was undertaken to assess updated evidence regarding the effectiveness and complications of the pulmonary recruitment maneuver (PRM) for reducing shoulder pain after laparoscopic gynecologic surgery. PRM with 40 cm H2O performed either alone or accompanied by IPS is a promising intervention for alleviating shoulder pain within 48 hours following gynecologic laparoscopy

Methods

Results

Conclusion