Evaluation of Interventions to Reduce Shoulder Pain Following Laparoscopic Surgery: A Systematic Review and Meta-Analysis

Background Objective: Very often the patients who undergo laparoscopic surgery suffer from shoulder pain (SP). As a result, different studies have been conducted to mitigate shoulder pain following laparoscopic surgery. This systematic review aims to investigate the efficacy of different interventions in mitigating laparoscopy-induced SP. Materials Methods: In this systematic review, relevant articles were included using ISI, PubMed, MEDLINE, etc., from 2009 to 2020. Medical Subject Headings (Mesh) of Laparoscopic Surgical Procedures, Surgery Laparoscopic, Laparoscopic Assisted, Shoulder Pain, randomized controlled trial, and clinical trial were searched for eligible studies. Random effect model and standardized mean difference (SMD) index were applied to combine the studies and perform a meta-analysis. Results: A total sample of 11,024 was obtained for 10 selected studies. Results from intraoperative intervention demonstrate that the mean VAS (visual analog scale) scores were 1.46(CI 95%: -0.32, 3.24) and 1.87(CI 95%:0.79, 2.94) in the intervention and control groups, respectively six hours after surgery. The mean VAS scores were 2.06(CI 95%: 0.91, 3.20) and 2.35 (CI 95%: 0.57, 4.13) in the intervention and control groups, respectively, twelve hours after surgery. 24 hours following surgery; the mean VAS scores were 0.96(CI 95%: -0.21, 2.13) and 1.27(CI 95%: 0.33, 2.21) in the intervention and control groups, respectively. Conclusion: The results of this meta-analysis demonstrate that intraoperative interventions, such as Peritoneal Suction Drainage, injection of Intraperitoneal Hydrocortisone with Bupivacaine, and warm and humidified insufflation carbon dioxide, can reduce the severity of SP in patients with LS. In addition, clinical trials with different interventions are needed to compare the efficacy and find effective interventions for SP management in patients with LS.