Pulmonary Recruitment Maneuver for Reducing Shoulder Pain after Laparoscopic Gynecologic Surgery: A Network Meta-Analysis of Randomized Controlled Trials.
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引用次数: 9
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.
背景:肩痛是腹腔镜手术后的常见症状。本系统综述旨在评估关于肺复支手法(PRM)减轻腹腔镜妇科手术后肩痛的有效性和并发症的最新证据。方法:检索截至2019年6月的随机对照试验(rct)数据库,研究PRM减轻肩部疼痛的作用。两位作者独立选择可能相关的随机对照试验,提取数据,评估偏倚风险,并比较结果。采用网络元分析同时比较多种干预措施。效果测量以合并平均差(MD)或风险比(RR)表示,并具有相应的95%置信区间(CI)。结果:在我们确定的44条记录中(不包括重复),包括1111名参与者的11项随机对照试验被纳入。三项研究存在不明确的选择偏倚风险。最大压力为40 cm H2O的PRM最有可能导致24小时肩痛强度最低(MD -1.91;95% CI为-2.06 ~ -1.76),而PRM最大压力为40 cm H2O +腹腔内生理盐水(IPS)在48小时时最有效(MD为-2.09;95% CI为-2.97 ~ -1.21)。在相互竞争的干预措施中,镇痛需求、恶心/呕吐和心肺事件的估计rr相似。结论:在妇科腹腔镜术后48小时内,单独或联合IPS进行40 cm H2O的PRM是一种很有希望的缓解肩部疼痛的干预措施。