Interventions to reduce shoulder pain following gynaecological laparoscopic procedures

Kaloo, Philip; Armstrong, Sarah; Kaloo, Claire; Jordan, Vanessa

doi:10.1002/14651858.cd011101.pub2

Cited by 42 publications

(58 citation statements)

References 88 publications

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“…Recently, Kaloo et al [23] updated their Cochrane review which was conducted to assess the interventions to reduce shoulder pain following gynecological laparoscopic procedures. Control in all comparisons in this review was abdominal compression.…”

Section: Discussionmentioning

confidence: 99%

“…This review included five and three RCTs for evaluating the incidence of shoulder pain at 72 hours and shoulder pain intensity at 24 hours among women undergoing PRM compared to those who received abdominal compression. This review noted that participants undergoing PRM experienced lower shoulder pain intensity than those who received abdominal compression although there was no significant difference in the incidence of shoulder pain among the comparison groups [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

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

Kietpeerakool

Rattanakanokchai

Yantapant

et al. 2020

Minimally Invasive Surgery

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Kietpeerakool

Rattanakanokchai

Yantapant

et al. 2020

Minimally Invasive Surgery

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“…Even though it remains unclear why a considerable number of patients experience shoulder pain after laparoscopy, peritoneal stretching and diaphragmatic irritation caused by CO 2 gas seem to play a significant role in its mechanism [9][10][11][12]. Thus, several trials have assessed the use of intraperitoneal local anesthetics with controversial results [13][14][15][16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Combination of a pulmonary recruitment maneuver and intraperitoneal bupivacaine for the reduction of postoperative shoulder pain in gynecologic laparoscopy: a randomized, controlled trial

et al. 2020

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Objective To compare the efficacy of a pulmonary recruitment maneuver using lower airway pressure (30 cm H 2 O) and intraperitoneal bupivacaine, alone or in combination, for reducing shoulder pain after gynecologic laparoscopy. Methods A prospective controlled study was performed in a teaching hospital with patients who underwent elective gynecologic laparoscopic surgery. Two hundred eighty-seven patients were randomized into 1 of 4 groups: group A, placebo; group B, intraperitoneal instillation of bupivacaine; group C, CO 2 removal by a pulmonary recruitment maneuver; group D, combination of intraperitoneal bupivacaine and pulmonary recruitment maneuver. The interventions were performed at the end of surgery. Shoulder pain was recorded on a visual analog scale (VAS) at 1, 6, 12, and 24 hours postoperatively. Results The overall incidence of shoulder pain was 49.8% and the incidence tended to gradually decrease from group A to group D (59.0% in group A, 54.8% in group B, 44.4% in group C, and 41.5% in group D; P=0.026). In addition, the VAS scores gradually decreased from group A to D, although a statistically significant difference was only found at 6 hours postoperatively (P=0.03). There were no complications related to the interventions. Conclusion The combination of a pulmonary recruitment maneuver with intraperitoneal bupivacaine significantly reduced shoulder pain after gynecologic laparoscopy. Trial Registration ClinicalTrials.gov Identifier: NCT01039441.

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“…Laparoscopic surgery is getting more popular due to fast recovery. In addition, laparoscopic surgery needs smaller incision, has less postoperative pain, and lower rate of mortality in comparison with laparotomy (1, 2). The reports show that incidence of shoulder pain after laparoscopic gynecologic surgery is 80% (1).…”

Section: Introductionmentioning

confidence: 99%

“…In addition, laparoscopic surgery needs smaller incision, has less postoperative pain, and lower rate of mortality in comparison with laparotomy (1, 2). The reports show that incidence of shoulder pain after laparoscopic gynecologic surgery is 80% (1). Shoulder pain can also be intense at 24 hours after laparoscopic hysterectomy (3).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Intraperitoneal Normal Saline Infusion with Pulmonary Recruitment Maneuver in Reducing Shoulder and Upper Abdomen Pain Following Gynecologic Laparoscopic Procedures: A Randomized, Controlled, Triple-Blind Trial

et al. 2019

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Objectives The current study aimed at evaluating the effect of intraperitoneal infusion of normal saline (NS) and pulmonary recruitment maneuver (PRM) on the reduction of pain in shoulder, upper abdomen, and incision site after elective laparoscopic gynecologic surgery. Methods Totally, 280 patients (mean age: 30.5 years) that underwent laparoscopic gynecologic surgery from October 2013 to August 2015 were randomly and equally allocated into four groups. Group A received intraperitoneal infusion of NS 1.5 - 2 mL/kg of body weight; group B received PRM with five manual pulmonary inflations at a maximum pressure of 60 cm H 2 O; group C simultaneously received two former interventions; and finally the control group D received routine method of gentle abdominal pressure. All patients were assessed in the first 24 hours after surgery. Results There was an unsteady pattern for pain in shoulder, upper abdomen, and incision site at different time points across the studied groups over the trial. Patients in group B showed significantly lower shoulder pain 24 hours after laparoscopic gynecologic surgery (P = 0.01), while patients in group D had significantly lower incision site pain (P < 0.001). Conclusions PRM was superior to intraperitoneal infusion of NS for reducing pain in the first 24 hours after laparoscopic gynecologic surgery.

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Interventions to reduce shoulder pain following gynaecological laparoscopic procedures

Abstract: Interventions to reduce shoulder pain following gynaecological laparoscopic procedures.

Cited by 42 publications

References 88 publications

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

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

Combination of a pulmonary recruitment maneuver and intraperitoneal bupivacaine for the reduction of postoperative shoulder pain in gynecologic laparoscopy: a randomized, controlled trial

Comparison of Intraperitoneal Normal Saline Infusion with Pulmonary Recruitment Maneuver in Reducing Shoulder and Upper Abdomen Pain Following Gynecologic Laparoscopic Procedures: A Randomized, Controlled, Triple-Blind Trial

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