Intraperitoneal instillation of saline and local anesthesia for prevention of shoulder pain after laparoscopic cholecystectomy: a systematic review.
BACKGROUND
The laparoscopic technique has many advantages compared with open surgery for symptomatic cholecystolithiasis. Despite these advantages, many patients complain about shoulder pain (SP) after laparoscopic cholecystectomy. The purpose of this review was to evaluate intraperitoneal instillation (IPI) of saline and local anesthesia (LA) to minimize SP.


METHODS
A search of the literature was conducted using PubMed and Excerpta Medica Database (EMBASE). Eligibility criteria were: randomized clinical trials (RCT) evaluating IPI of saline and/or LA to minimize incidence or severity of SP after laparoscopic cholecystectomy. Only papers published in English were included. Data extracted were year of publication, number of participants and allocation, timing of IPI, and nonsignificant or significant effect on incidence or severity of SP.


RESULTS
A total of 24 RCTs were included in the review. Four RCTs reported results on IPI saline as intervention versus nothing as control. Seven RCTs reported results on IPI LA as intervention versus nothing as control. Sixteen RCTs reported results on IPI LA as intervention versus saline as control. IPI saline resulted in a significant reduction in SP severity compared with nothing. IPI LA was associated with an overall significant reduction of SP severity compared with nothing. Results regarding the effect IPI LA versus saline showed contradictory results in regards to both SP incidence and severity.


CONCLUSIONS
Both IPI of saline and LA can be used to reduce SP severity after laparoscopic cholecystectomy. It is not possible to conclude whether the incidence of SP can be reduced with saline or LA, due to contradictive results.
Department of Surgery, Center for Perioperative Optimization, Herlev Hospital, University Hospital of Copenhagen, Herlev Ringvej 75, 2730 Herlev, Denmark. andersdonatsky@gmail.com
Anders Meller
AM
Donatsky
Flemming
F
Bjerrum
Ismail
I
Gögenur
D000772:Anesthesia, Local; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D006801:Humans; D007263:Infusions, Parenteral; D010149:Postoperative Pain / Q000517:prevention & control*; D053591:Referred Pain / Q000209:etiology / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D020069:Shoulder Pain / Q000209:etiology / Q000517:prevention & control*; D012965:Sodium Chloride / Q000627:therapeutic use*
D012965:Sodium Chloride