Pulmonary recruitment maneuver to reduce pain after laparoscopy: a meta-analysis of randomized controlled trials

We investigated the impact of pulmonary recruitment maneuver in reducing shoulder pain after laparoscopic procedure. We conducted a systematic review of the literature using Medline (1966-2014), Scopus (2004-2014), Popline (1974-2014), (2008-2014), and Google Scholar (2004-2014) along with reference lists of electronically retrieved studies. Statistical meta-analysis was performed using the RevMan 5.1 software. Six studies were included in the present systematic review, involving 571 patients. Among them, 291 (51 %) were offered a pulmonary recruitment maneuver, and 280 patients (49 %) were treated with conventional evacuation of pneumoperitoneum that included either passive evacuation or gentle pressing of the abdominal walls with the trocar ports open. The introduction of a pulmonary recruitment maneuver significantly decreased postoperative shoulder pain 12 h (435 patients, REM, MD -1.55, 95 % CI -2.01, -1.10), 24 h (435 patients, REM, MD -1.59, 95 % CI -2.00, -1.18), and 48 h post-operatively (335 patients, REM, MD -0.93, 95 % CI -1.37, -0.50). We also identified evidence of a potential beneficial effect in the reduction of postoperative upper abdominal pain. However, discrepancies in the interpretation of abdominal pain among the included studies precluded meta-analysis of this index. According to the results of our meta-analysis, pulmonary recruitment maneuver seems to be an easily performed, potentially preventive measure of post-laparoscopic shoulder pain. Further research is mandated, however, in the field, because firm results are precluded by the small number of included studies.