Cochrane · systematic review · CD011101
Interventions to reduce shoulder pain following gynaecological laparoscopic procedures
Kaloo, P, Armstrong, S, Kaloo, C, et al. · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library
Gynaecology and FertilityAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
28
current version
GRADE rated
18
No studies
8
Included studies
NR
No studies 8 · 28.6%Ungraded 2 · 7.1%Very low 1 · 3.6%Low 13 · 46.4%Moderate 4 · 14.3%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Specific technique compared to standard technique for releasing the pneumoperitoneum for the reduction of shoulder pain following gynaecological laparoscopic procedures
Population: women undergoing a diagnostic or operative laparoscopic gynaecological procedure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Incidence of STP at 24 hours post‐operatively Specific technique vs standard technique | OR 0.87 [0.41, 1.82] | 1 study · 118 participants | Low Downgraded: risk of bias, imprecision |
Severity of STP at 24 hours post‐operatively Specific technique vs standard technique | no estimate extracted | 5 studies · 670 participants | Low Downgraded: risk of bias, imprecision |
Adverse events Specific technique vs standard technique | no estimate extracted | 1 study · 74 participants | Ungraded |
Analgesia usage during study Specific technique vs standard technique | no estimate extracted | 4 studies · 570 participants | Low Downgraded: risk of bias, inconsistency |
Fluid instillation compared to no fluid instillation for the reduction of shoulder pain following gynaecological laparoscopic procedures
Population: women undergoing a diagnostic or operative laparoscopic gynaecological procedure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Incidence of STP at 24 hours post‐operatively Fluid instillation vs no fluid instillation | OR 0.38 [0.22, 0.66] | 2 studies · 220 participants | Moderate Downgraded: risk of bias, imprecision |
Severity of STP at 24 hours post‐operatively Fluid instillation vs no fluid instillation | no estimate extracted | 2 studies · 205 participants | Moderate Downgraded: risk of bias, imprecision |
Adverse events Fluid instillation vs no fluid instillation | no estimate extracted | NR | No studies |
Analgesia usage (meperidine mg) within 24 hours post‐operatively Fluid instillation vs no fluid instillation | no estimate extracted | 2 studies · 205 participants | Low Downgraded: risk of bias, imprecision |
Intraperitoneal drain compared to no intraperitoneal drain for the reduction of shoulder pain following gynaecological laparoscopic procedures
Population: women undergoing a diagnostic or operative laparoscopic gynaecological procedure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Incidence of STP at 24 hours post‐operatively Intraperitoneal drain vs no intraperitoneal drain | OR 0.3 [0.2, 0.46] | 3 studies · 417 participants | Low Downgraded: risk of bias, inconsistency |
Severity of STP at 24 hours post‐operatively Intraperitoneal drain vs no intraperitoneal drain | no estimate extracted | 3 studies · 320 participants | Very low Downgraded: risk of bias, inconsistency |
Adverse events Intraperitoneal drain vs no intraperitoneal drain | no estimate extracted | NR | No studies |
Analgesia usage within 48 hours post‐operatively Intraperitoneal drain vs no intraperitoneal drain | no estimate extracted | 2 studies · 253 participants | Low Downgraded: risk of bias, inconsistency |
Subdiaphragmatic intraperitoneal local anaesthetic compared to control for the reduction of shoulder pain following gynaecological laparoscopic procedures
Population: women undergoing a diagnostic or operative laparoscopic gynaecological procedure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Incidence of STP at 24 hours post‐operatively Subdiaphragmatic intraperitoneal local anaesthetic vs control | OR 0.72 [0.42, 1.23] | 4 studies · 336 participants | Moderate Downgraded: risk of bias |
Severity of STP at 24 hours post‐operatively Subdiaphragmatic intraperitoneal local anaesthetic vs control | no estimate extracted | 1 study · 50 participants | Low Downgraded: risk of bias, imprecision |
Adverse events Subdiaphragmatic intraperitoneal local anaesthetic vs control | no estimate extracted | 3 studies · 165 participants | Ungraded |
Analgesia usage within 24‐48 hours post‐operatively Subdiaphragmatic intraperitoneal local anaesthetic vs control | no estimate extracted | 2 studies · 129 participants | Low Downgraded: risk of bias, inconsistency |
Local anaesthetic to peritoneal cavity (not subdiaphragmatic) compared to control for the reduction of shoulder pain following gynaecological laparoscopic procedures
Population: women undergoing gynaecological laparoscopic procedures
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Incidence of STP within 4‐8 hours post‐operatively Local anaesthetic to peritoneal cavity (not subdiaphragmatic) vs control | OR 0.23 [0.06, 0.93] | 2 studies · 157 participants | Low Downgraded: risk of bias, inconsistency |
Severity of STP Local anaesthetic to peritoneal cavity (not subdiaphragmatic) vs control | no estimate extracted | NR | No studies |
Adverse events Local anaesthetic to peritoneal cavity (not subdiaphragmatic) vs control | no estimate extracted | NR | No studies |
Analgesia usage Local anaesthetic to peritoneal cavity (not subdiaphragmatic) vs control | no estimate extracted | NR | No studies |
Warmed, or warmed and humidified CO2 compared to unwarmed and unhumidified CO2 for the reduction of shoulder pain following gynaecological laparoscopic procedures
Population: women undergoing gynaecological laparoscopic procedures
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Incidence of STP within 24‐48 hours post‐operatively Warmed, or warmed and humidified CO2 vs unwarmed and unhumidified CO2 | OR 0.81 [0.45, 1.49] | 2 studies · 194 participants | Low Downgraded: risk of bias, imprecision |
Severity of STP at 24 hours post‐operatively Warmed, or warmed and humidified CO2 vs unwarmed and unhumidified CO2 | no estimate extracted | 2 studies · 157 participants | Moderate Downgraded: imprecision |
Adverse events Warmed, or warmed and humidified CO2 vs unwarmed and unhumidified CO2 | no estimate extracted | NR | No studies |
Analgesia usage (morphine mg) over 48 hours post‐operatively Warmed, or warmed and humidified CO2 vs unwarmed and unhumidified CO2 | no estimate extracted | 1 study · 95 participants | Low Downgraded: imprecision |
Gasless laparoscopy compared to CO2 insufflation for the reduction of shoulder pain following gynaecological laparoscopic procedures
Population: women undergoing gynaecological laparoscopic procedures
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Incidence of STP Gasless laparoscopy vs CO2 insufflation | no estimate extracted | NR | No studies |
Severity of STP over 72 hours post‐operatively Gasless laparoscopy vs CO2 insufflation | no estimate extracted | 1 study · 54 participants | Low Downgraded: risk of bias, imprecision |
Adverse events Gasless laparoscopy vs CO2 insufflation | OR 2.56 [0.25, 26.28] | 1 study · 54 participants | Low Downgraded: risk of bias, imprecision |
Analgesia usage Gasless laparoscopy vs CO2 insufflation | no estimate extracted | NR | No studies |