Intraperitoneal Crystalloid Instillation to Reduce Shoulder-Tip Pain After Benign Gynecologic Laparoscopy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

OBJECTIVE

To evaluate the effectiveness of intraperitoneal crystalloid fluid instillation in reducing postoperative shoulder-tip pain and related outcomes after elective gynecologic laparoscopy for benign conditions.

DATA SOURCES: A systematic search of PubMed, Embase, and the Cochrane Central Register of Controlled Trials was conducted up to December 2025. Search terms included combinations of "gynecologic laparoscopy", "shoulder pain", "intraperitoneal," "saline," and "ringer's lactate."

METHODS OF STUDY SELECTION: Randomized controlled trials comparing intraperitoneal crystalloid fluid instillation (normal saline or Ringer's lactate) with standard desufflation techniques without intraperitoneal fluid instillation in women undergoing elective benign gynecologic laparoscopy were included.

TABULATION, INTEGRATION, AND

RESULTS

Data were independently extracted by 2 reviewers. Continuous endpoints were compared using pooled mean differences (MDs) and binary outcomes with risk ratios (RR), with 95% confidence intervals (CIs). Statistical analysis was performed using R statistical software version 4.5.1 (R Foundation for Statistical Computing). Primary outcomes included shoulder-tip pain intensity measured by visual analog scale (VAS: 1-10) or numeric rating scales at 12, 24, and 48 hours postoperatively, with a 1-point reduction being clinically significant. Secondary outcomes included abdominal pain at 12, 24, and 48 hours, postoperative abdominal distension, estimated blood loss, operative time, postoperative hospital stay, and postoperative nausea and vomiting. Eleven RCTs were included, comprising a total of 1143 patients. Intraperitoneal crystalloid instillation was associated with a significant reduction in postoperative shoulder-tip pain at 12 hours (MD: -1.46; 95% CI: -2.56 to -0.36; PI: -4.07 to 1.15; p = .02), 24 hours (MD: -1.17; 95% CI: -2.10 to -0.24; PI: -3.64 to 1.29; p = .02), and 48 hours (MD -0.96; 95% CI: -1.84 to -0.08; PI: -2.92 to 1.00; p = .04) compared with standard dessuflation techniques. No differences were observed in secondary outcomes, including abdominal pain at 12, 24, and 48 hours, postoperative abdominal distension, estimated blood loss, operative time, postoperative hospital stay, or incidence of postoperative nausea and vomiting. Furthermore, in studies where postoperative NSAIDs were routinely administered, intraperitoneal crystalloid instillation did not demonstrate a reduction in shoulder-tip pain.

CONCLUSION

Intraperitoneal crystalloid fluid instillation was associated with a reduction in postoperative shoulder-tip pain following laparoscopic gynecologic surgery for benign conditions, without evidence of adverse effects on other perioperative outcomes. These findings suggest that this simple and low-cost intervention may be considered as an adjunct to reduce postoperative pain in patients undergoing laparoscopic gynecologic surgery for benign conditions.