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

Cho, Minae; Kim, Chul Jung; Hahm, Tae Soo; Lee, Yoo-Young; Kim, Tae-Joong; Lee, Jeong‐Won; Kim, Byoung-Gie; Bae, Duk-Soo; Choi, Chel Hun

doi:10.5468/ogs.2020.63.2.187

Cited by 8 publications

(9 citation statements)

References 39 publications

(50 reference statements)

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“…Eleven trials compared recruitment maneuvers to no recruitment maneuvers (Supplemental Digital Content 2, eTable 16, http://links.lww.com/AA/D970). 8,63–72 Only 2 of the trials included >200 patients. All trials were performed on patients undergoing laparoscopic surgery, and 6 had surgery or anesthesia duration of >2 hours.…”

Section: Resultsmentioning

confidence: 99%

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Ventilation Strategies During General Anesthesia for Noncardiac Surgery: A Systematic Review and Meta-Analysis

Bolther¹,

Henriksen²,

Holmberg

et al. 2022

Anesthesia &Amp; Analgesia

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BACKGROUND: The optimal ventilation strategy during general anesthesia is unclear. This systematic review investigated the relationship between ventilation targets or strategies (eg, positive end-expiratory pressure [PEEP], tidal volume, and recruitment maneuvers) and postoperative outcomes. METHODS: PubMed and Embase were searched on March 8, 2021, for randomized trials investigating the effect of different respiratory targets or strategies on adults undergoing noncardiac surgery. Two investigators reviewed trials for relevance, extracted data, and assessed risk of bias. Meta-analyses were performed for relevant outcomes, and several subgroup analyses were conducted. The certainty of evidence was evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: This review included 63 trials with 65 comparisons. Risk of bias was intermediate for all trials. In the meta-analyses, lung-protective ventilation (ie, low tidal volume with PEEP) reduced the risk of combined pulmonary complications (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.28–0.49; 9 trials; 1106 patients), atelectasis (OR, 0.39; 95% CI, 0.25–0.60; 8 trials; 895 patients), and need for postoperative mechanical ventilation (OR, 0.36; 95% CI, 0.13–1.00; 5 trials; 636 patients). Recruitment maneuvers reduced the risk of atelectasis (OR, 0.44; 95% CI, 0.21–0.92; 5 trials; 328 patients). We found no clear effect of tidal volume, higher versus lower PEEP, or recruitment maneuvers on postoperative pulmonary complications when evaluated individually. For all comparisons across targets, no effect was found on mortality or hospital length of stay. No effect measure modifiers were found in subgroup analyses. The certainty of evidence was rated as very low, low, or moderate depending on the intervention and outcome. CONCLUSIONS: Although lung-protective ventilation results in a decrease in pulmonary complications, randomized clinical trials provide only limited evidence to guide specific ventilation strategies during general anesthesia for adults undergoing noncardiac surgery.

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Section: Resultsmentioning

confidence: 99%

“…Eleven trials compared recruitment maneuvers to no recruitment maneuvers (Supplemental Digital Content 2, eTable 16, http://links.lww.com/AA/ D970). 8,[63][64][65][66][67][68][69][70][71][72] Two treatment groups: 1 with normocapnia and 1 with hypercapnia. These were combined in meta-analyses.…”

Section: Recruitment Maneuversmentioning

confidence: 99%

Ventilation Strategies During General Anesthesia for Noncardiac Surgery: A Systematic Review and Meta-Analysis

Bolther¹,

Henriksen²,

Holmberg

et al. 2022

Anesthesia &Amp; Analgesia

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“…Eleven publications investigated the effect of recruitment maneuvers on pain and/or PONV 48–58 . All trials included ≤150 patients with all patients undergoing surgery in the abdominal region.…”

Section: Resultsmentioning

confidence: 99%

“…Eleven publications investigated the effect of recruitment maneuvers on pain and/or PONV. [48][49][50][51][52][53][54][55][56][57][58] All trials included ≤150 patients with all patients undergoing surgery in the abdominal region. Ten of the trials compared recruitment maneuvers consisting of 2-6 manual pulmonary inflations with pressure up to 60 cmH 2 O with no recruitment maneuvers.…”

Section: Recruitment Maneuvermentioning

confidence: 99%

Intraoperative respiratory and hemodynamic strategies for reducing nausea, vomiting, and pain after surgery: Systematic review and meta‐analysis

Holst

Klitholm

Henriksen

et al. 2022

Acta Anaesthesiol Scand

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Background: Despite improved medical treatment strategies, postoperative pain, nausea, and vomiting remain major challenges. This systematic review investigated the relationship between perioperative respiratory and hemodynamic interventions and postoperative pain, nausea, and vomiting. Methods: PubMed and Embase were searched on March 8, 2021 for randomized clinical trials investigating the effect of perioperative respiratory or hemodynamic interventions in adults undergoing non-cardiac surgery. Investigators reviewed trials for relevance, extracted data, and assessed risk of bias. Meta-analyses were performed when feasible. GRADE was used to assess the certainty of the evidence.Results: This review included 65 original trials; of these 48% had pain, nausea, and/or vomiting as the primary focus. No reduction of postoperative pain was found in meta-analyses when comparing recruitment maneuvers with no recruitment, high (80%) to low (30%) fraction of oxygen, low (5-7 ml/kg) to high (9-12 ml/kg) tidal volume, or goal-directed hemodynamic therapy to standard care.

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“…Moreover, lower intra-abdominal acidosis leads to lower peritoneal or phrenic nerve irritation. 11 With regard to the mechanism of LRM, the researchers decided to utilize a technique similar to this mechanism to remove residual CO 2 in the abdominal cavity.…”

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confidence: 99%

The Impact of Incentive Spirometry on Shoulder Tip Pain in Laparoscopic Cholecystectomy: A Randomized Clinical Trial

Saremirad¹,

Yazdimoghaddam

Dalili

et al. 2021

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: Shoulder pain is among the early postlaparoscopic symptoms related to carbon dioxide used for pneumoperitoneum, which remains in the abdominal cavity. Therefore, incentive spirometry (IS) is a novel technique to alleviate this pain following laparoscopic cholecystectomy (LC). The present study was designed to investigate if the use of IS after LC would relieve shoulder tip pain, and determine the amount of postoperative opioid analgesics utilized.Materials and Methods: This randomized clinical trial was conducted on patients who were clinically diagnosed with cholecystitis, and underwent LC. Accordingly, group I patients (n = 42) received IS (including 10 deep breaths with a spirometer in sitting or semisitting positions) in full consciousness every 2 hours starting at 2 hours after surgery, but group II patients (n = 42) did not have respiratory physiotherapy. The postoperative shoulder pain after the surgery was further evaluated by a numerical rating scale (NRS).Results: At 4, 8, 12, 24, and 48 hours following LC, the NRS pain scores significantly reduced in group I compared with group II. In addition, the results of the repeated measures analysis of variance indicated significantly lower NRS pain scores within the first 48 hours after LC in group I compared with group II. Consequently, the study findings showed a significantly higher percentage of cases in group II, requiring postoperative analgesics, in comparison with group I.Conclusions: IS decreased the severity of shoulder tip pain after LC with no complications. Thus, IS may be considered as a viable alternative to other laparoscopic interventions. However, still further studies are necessary to evaluate its efficacy compared with other techniques.

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

Cited by 8 publications

References 39 publications

Ventilation Strategies During General Anesthesia for Noncardiac Surgery: A Systematic Review and Meta-Analysis

Ventilation Strategies During General Anesthesia for Noncardiac Surgery: A Systematic Review and Meta-Analysis

Intraoperative respiratory and hemodynamic strategies for reducing nausea, vomiting, and pain after surgery: Systematic review and meta‐analysis

The Impact of Incentive Spirometry on Shoulder Tip Pain in Laparoscopic Cholecystectomy: A Randomized Clinical Trial

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