Comparison of maneuvers to reduce shoulder pain after laparoscopic gynecological surgery: a meta-analysis of randomized controlled studies.

Abstract

Background: the impact of different maneuvers to reduce shoulder pain after gynecological laparoscopy surgery was investigated.
Methodology: A systematic review and meta-analysis was carried out by searching in the databases PUBMED, SCIENCEDIRECT, LILLACS and COCHRANE. We included studies published from 2008 to 2017, which compared different maneuvers for the prevention of shoulder pain after gynecological laparoscopic surgery. The statistical meta-analysis was performed using the RevMan 5.1 program.
Results: Of the 56 articles analyzed, 6 were included that fulfilled the selection criteria, for a total of 743 patients. Of which 302 (40%) were given manual pulmonary insufflations with change of position, 104 (14%) were instilled with physiological saline in the peritoneal cavity, and 337 (46%) were treated with conventional evacuation that included passive extraction or gentle pressure on the abdominal wall with open trocars. We found that when performing instillation of physiological serum in the peritoneal cavity, the shoulder pain was significantly reduced at 12 hours with a Means Difference (MD) of -16. 90 (CI 95% -25.45- -8.34), at 24h with a MD of -22.71 (IC 95% -30.62- -14.80) and at 48h with a MD of -14.42 (CI 95% -20.67- -8, 17). On the other hand, using manual pulmonary insufflations with change of position of the patient, the shoulder pain was significantly reduced at 12h (MD: -16.84, CI 95%: -22.66, -11.01), at 24h (MD: -11.66, CI 95%: -14.80- -8.51) and 48 h (DM: -9.25; CI 95%: -11.94- -6.56). When observing the results by subgroup of the different interventions, we found that the instillation maneuver of physiological serum in the peritoneal cavity has better results than manual pulmonary insufflations and the control for the prevention of postoperative pain in gynecological laparoscopic surgery.
Conclusion: Our study suggests that the maneuvers associated with forced expulsion of CO2, with pulmonary insufflation with change of position or instillation of the abdominal cavity with physiological solution, are effective measures for the prevention and reduction of shoulder pain after gynecological laparoscopy, compared with the passive extraction of CO2. Preventive measures should be routinely incorporated into gynecological laparoscopic procedures, as long as patients are clinically fit for these procedures.