Minimally Invasive Surgery

Review Article

Pulmonary Recruitment Maneuver for Reducing Shoulder Pain after Laparoscopic Gynecologic Surgery: A Network Meta-Analysis of Randomized Controlled Trials

Table 1

Network-estimated effect measures of intervention on shoulder pain.
Pain scores of shoulder pain at 24 hours—mean difference of VAS (95% confidence intervals)
Abdominal compression    
 −1.91 (−2.06, −1.76)PRM 40 cm H2O   
 −1.75 (−2.48, −1.02)0.16 (−0.58, 0.90)PRM 40 cm H2O plus IPS  
 −1.49 (−1.64, −1.34)0.42 (0.21, 0.63)0.26 (−0.48, 1.00)PRM 60 cm H2O 
 −1.53 (−2.28, −0.78)0.38 (−0.38, 1.15)0.22 (−0.69, 1.13)−0.04 (−0.80, 0.72)PRM 60 cm H2O plus IPS
Scores of shoulder pain at 48 hours—mean difference of VAS (95% confidence intervals)
Abdominal compression    
 −0.58 (−1.20, 0.05)PRM 40 cm H2O   
 −2.09 (−2.97, −1.21)−1.52 (−2.60, −0.44)PRM 40 cm H2O plus IPS  
 −0.26 (−1.55, 1.03)0.32 (−1.12, 1.75)1.83 (0.28, 3.39)PRM 60 cm H2O 
 −1.46 (−2.36, −0.55)−0.88 (−1.98, 0.22)0.64 (−0.42, 1.70)−1.20 (−2.77, 0.37)PRM 60 cm H2O plus IPS
Incidence of shoulder pain at 24 hours—risk ratio (95% confidence intervals)
Abdominal compression    
 —PRM 40 cm H2O   
 0.69 (0.51, 0.95)—PRM 40 cm H2O plus IPS  
 0.91 (0.70, 1.18)—1.31 (0.88, 1.96)PRM 60 cm H2O 
 0.66 (0.46, 0.93)—0.95 (0.59, 1.51)0.72 (0.47, 1.11)PRM 60 cm H2O plus IPS
Incidence of shoulder pain at 48 hours—risk ratio (95% confidence intervals)
Abdominal compression    
 0.77 (0.58, 1.03)PRM 40 cm H2O   
 0.73 (0.48, 1.11)0.95 (0.57, 1.58)PRM 40 cm H2O plus IPS  
 0.81 (0.66, 0.99)1.05 (0.74, 1.50)1.11 (0.69, 1.77)PRM 60 cm H2O 
 0.60 (0.36, 1.00)0.78 (0.44, 1.40)0.82 (0.42, 1.58)0.74 (0.43, 1.28)PRM 60 cm H2O plus IPS
VAS: visual analogue scale (0–10); PRM 40: pulmonary recruitment maneuver 40 cm H2O; PRM 60: pulmonary recruitment maneuver 60 cm H2O; IPS: intraperitoneal saline.