Phrenic nerve block with 2% lidocaine should be performed in all patients undergoing a major thoracic surgery procedure. These results strongly support the hypothesis that irritation of the pericardium and/or mediastinal-diaphragmatic pleural surfaces results in pain that is referred to the shoulder via the phrenic nerve.

In clinical practice, systematic sampling of the mediastinum by EBUS-TBNA, regardless of PET/CT features, is to be recommended over targeted sampling.

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