Pulmonary recruitment maneuver reduces the intensity of post-laparoscopic shoulder pain: a systematic review and meta-analysis

Abstract

Background: Post-laparoscopic shoulder pain (PLSP) is a commonplace complication following laparoscopic surgeries. This meta-analysis aimed to investigate whether pulmonary recruitment maneuver (PRM) was beneficial to alleviate shoulder pain after laparoscopic procedures. Methods: We conducted literature research in electronic database from the date of inception to 31 January 2022. The relevant RCTs were independently selected by two authors, followed by data extraction, risk of bias assessing, and results comparison. Results: Fourteen studies were included in our study involving 1504 patients, among which 607 patients were offered pulmonary recruitment maneuver (PRM) alone or PRM combined with intraperitoneal saline instillation (IPSI) and 573 patients were treated with passive abdominal compression. The administration of PRM significantly decreased post-laparoscopic shoulder pain score at 12h (MD (95%CI) -1.12(-1.57 to -0.66),801 patients, P<0.00001, I2=88%); at 24h (MD (95%CI) -1.45(-1.74 to -1.16), 1180 patients, P<0.00001, I2=78%) and at 48h (MD (95%CI) -0.97(-1.57 to -0.36),780 patients, P<0.00001, I2=85%). Conclusion: This systematic review and meta-analysis showed that PRM can reduce the intensity of PLSP. However, more studies may be needed to explore the usefulness of PRM in more types of laparoscopic operations other than gynecological surgery and determine the optimal pressure of PRM or appropriate combination with other measures.