Effect of ultrasound-guided phrenic nerve block on shoulder pain after laparoscopic cholecystectomy—a prospective, randomized controlled trial
AIM To assess the effectiveness of intra-abdominal drainage (IAD) post laparoscopic cholecystectomy (LC). METHODS Main electronic databases [MEDLINE via Pubmed, EMBASE, Scopus, Web of Knowledge, Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Library, and clinical trial registry (ClinicalTrial.gov)] were searched for randomised controlled trial (RCT) reporting outcomes of IAD. The systematic review was conducted in accordance with the PRISMA guidelines and meta-analysis was analysed using fixed and random-effects models. RESULTS Twelve RCTs involving 1763 patients (897 drained versus 866 without drain) were included in the final pooled analysis. There was no statistically significant different in the rate of intra-abdominal collections (RR 1.08, 95% CI 0.78 to 1.49; p = 0.65). IAD did not reduce the overall incidence of nausea and vomiting (RR 1.10, 95% CI 0.90 to 1.36; p = 0.36) and shoulder tip pain (RR 0.99, 95% CI 0.69 to 1.40; p = 0.93). Drain group had a significant higher pain scores (measured by visual analogue scale) (MD 10.08, 95% CI 5.24 to 14.92; p < 0.00001). IAD prolonged operative time (MD 4.93 min, 95% CI 3.40 to 6.47; p < 0.00001) but not the length of hospital stay (MD 0.22 day, 95% CI -0.45 to 0.89; p = 0.52). Wound infection was found to be unrelated to the use of a drain (RR 1.86, 95% CI 0.95 to 3.63; p = 0.07). CONCLUSIONS There is no significant advantage of IAD placement. The routine use of abdominal drain seems to have unfavourable clinical outcome and the practice should be carefully re-considered.