College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
King Abdullah International Medical Research Center (KAIMRC), Jeddah, Saudi Arabia.
Surg Endosc. 2024 Feb;38(2):597-606. doi: 10.1007/s00464-023-10651-4. Epub 2024 Jan 11.
Postoperative pain is a common issue following laparoscopic cholecystectomy. This meta-analysis aimed to determine if active gas aspiration is more effective than passive gas aspiration in reducing postoperative pain and analgesic requirements.
The study conducted a systematic search of various databases, including Embase, Medline, and Cochrane Central Register of Controlled Trials (CENTRAL) via Ovid. It also searched trial registries and reference lists of included studies, with no date restrictions but limited to English language, up to December 21, 2022. The study included all randomized clinical trials that had documented elective laparoscopic cholecystectomy procedure and reported at least one relevant outcome. Articles that included subdiaphragmatic drain, intraperitoneal normal saline infusion, or pulmonary recruitment maneuver were excluded from the analysis. Two reviewers independently and in duplicate assessed the eligibility of studies and extracted data. The study reported findings according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. The risk of bias of the included trials was assessed using the Revised Cochrane Risk of Bias Assessment Tool. The study used a random-effects model to pool data.
This meta-analysis included 5 randomized clinical trials with 367 participants and found that active gas aspiration resulted in significantly lower residual gas volume and total analgesia requirements compared to passive gas aspiration. Active gas aspiration also led to significantly lower shoulder pain scores at 24 h postoperatively. However, no significant differences were observed in hospital stay duration or abdominal pain scores.
The study found that active gas aspiration can be effective in reducing postoperative shoulder pain and analgesic requirements after laparoscopic cholecystectomy, which has important implications for patient care and healthcare costs. Importantly, this intervention does not impose any additional time or financial burden. However, further research is needed to evaluate its impact on other laparoscopic procedures.
腹腔镜胆囊切除术后的疼痛是一个常见问题。本荟萃分析旨在确定主动气体抽吸是否比被动气体抽吸更能有效减少术后疼痛和镇痛需求。
研究对各种数据库进行了系统检索，包括 Embase、Medline 和 Cochrane 对照试验中心注册库（CENTRAL）通过 Ovid。还检索了试验注册库和纳入研究的参考文献列表，无日期限制，但仅限于英语，截至 2022 年 12 月 21 日。该研究纳入了所有记录有选择性腹腔镜胆囊切除术的随机临床试验，并报告了至少一个相关结局。排除了包含膈下引流管、腹腔内生理盐水输注或肺复张手法的文章。两名审查员独立并重复评估研究的合格性并提取数据。该研究按照系统评价和荟萃分析的首选报告项目（PRISMA）指南报告了发现。使用修订后的 Cochrane 偏倚风险评估工具评估纳入试验的偏倚风险。该研究使用随机效应模型汇总数据。
这项荟萃分析纳入了 5 项随机临床试验，共 367 名参与者，发现与被动气体抽吸相比，主动气体抽吸可显著降低残余气体量和总镇痛需求。主动气体抽吸还导致术后 24 小时的肩部疼痛评分显著降低。然而，在住院时间或腹痛评分方面没有观察到显著差异。
该研究发现，主动气体抽吸可有效减少腹腔镜胆囊切除术后的肩部疼痛和镇痛需求，这对患者护理和医疗保健成本具有重要意义。重要的是，这种干预不会带来任何额外的时间或经济负担。然而，需要进一步研究来评估其对其他腹腔镜手术的影响。
