Incidence and Risk Factors Associated With Ipsilateral Shoulder Pain After Thoracic Surgery

Bunchungmongkol, Nutchanart; Pipanmekaporn, Tanyong; Paiboonworachat, Sahattaya; Saeteng, Somcharoen; Tantraworasin, Apichat

doi:10.1053/j.jvca.2013.10.008

Cited by 26 publications

(21 citation statements)

References 21 publications

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“…The relationship between a longer duration of surgery in the lateral decubitus position and ISP has been suggested as an explanation for the role of strain of the shoulder joint capsule and ligaments in the etiology of ISP [6, 20]. Patients with a higher Body Mass Index (BMI) report an increased prevalence of postthoracotomy IPS, representing a possibly higher strain on the shoulder and thus supporting this hypothesis in another study [22].…”

Section: Etiologymentioning

confidence: 75%

“…Postthoracic surgery ISP is reported as moderate to severe in the majority of patients [3, 6, 8, 15–18]. In approximately half of the patients, ISP was located at the posterior side of the shoulder [6], but it may be felt around the deltoid region [16, 18], the superior-posterior area of the shoulder [3], or the lateral third of the clavicle [17]. All those areas share innervation from C4 and C5 with the diaphragm.…”

Section: Pain Characteristicsmentioning

confidence: 99%

“…As ISP may be aggravated by movement, it is suggestive for a somatic rather than neuropathic origin of pain [6]. However, both inflammatory [3] and neuropathic [19] behavior had been suggested for ISP.…”

Section: Etiologymentioning

confidence: 99%

“…It had been suggested that the shoulder pain after thoracotomy could be caused by strain of ligaments and muscles of scapula [17], arcuation of patient in lateral decubitus position [13], or ligament injury following rib retraction [20]. Furthermore, the localization of ISP to the posterior side of shoulder, in a majority of patients, could suggest the muscle strain around the scapula as the cause of ISP [6]. …”

Section: Etiologymentioning

confidence: 99%

“…However, in a prospective observational study by Bunchungmongkol et al, the potential risk factors for developing ISP were surgery performed by a thoracotomy approach compared with Video-Assisted Thoracoscopic Surgeries (VATS) (risk ratio: 2.12, 95% confidence interval: 1.16–3.86, p = 0.014) and surgery duration >2 hours (risk ratio: 1.61, 95% confidence interval: 1.07–2.44, p = 0.023) [6]. In a retrospective study by Misiołek et al, higher Body Mass Index (BMI), thoracotomy versus VATS approaches, and epidural catheter level lower than T5 were found to be associated with a higher prevalence of IPS [22].…”

Section: Risk Factorsmentioning

confidence: 99%

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Postthoracotomy Ipsilateral Shoulder Pain: A Literature Review on Characteristics and Treatment

Yousefshahi

Predescu

Colizza

et al. 2016

Pain Research and Management

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Context. Postthoracotomy Ipsilateral Shoulder Pain (IPS) is a common and sometimes intractable pain syndrome. IPS is different from chest wall pain in type, origin, and treatments. Various treatments are suggested or applied for it but none of them is regarded as popular accepted effective one. Objectives. To review data and collect all present experiences about postthoracotomy IPS and its management and suggest future research directions. Methods. Search in PubMed database and additional search for specific topics and review them to retrieve relevant articles as data source in a narrative review article. Results. Even in the presence of effective epidural analgesia, ISP is a common cause of severe postthoracotomy pain. The phrenic nerve has an important role in the physiopathology of postthoracotomy ISP. Different treatments have been applied or suggested. Controlling the afferent nociceptive signals conveyed by the phrenic nerve at various levels—from peripheral branches on the diaphragm to its entrance in the cervical spine—could be of therapeutic value. Despite potential concerns about safety, intrapleural or phrenic nerve blocks are tolerated well, at least in a selected group of patient. Conclusion. Further researches could be directed on selective sensory block and motor function preservation of the phrenic nerve. However, the safety and efficacy of temporary loss of phrenic nerve function and intrapleural local anesthetics should be assessed.

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Section: Etiologymentioning

confidence: 75%