Post-thoracotomy shoulder pain and gabapentin: a tale of two enigmas

MacDougall, Peter; Slinger, Peter

doi:10.1007/bf03021486

Cited by 5 publications

(3 citation statements)

References 15 publications

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“…ISP appears to originate most commonly from an irritation of the diaphragm and mediastinal pleura, and, to a lesser extent, from shoulder strain due to positioning during surgery (39,78). TEA and opioids have a poor impact on the severity of ISP and multimodal interventions are often required to adequately treat and reduce its incidence (73,75,76,79,80).…”

Section: Part 3: Postoperative Isp In Thoracic Surgerymentioning

confidence: 99%

Perioperative pain management for thoracic surgery: a narrative review of the literature

Clairoux¹,

Issa²,

Bélanger³

et al. 2023

Curr Chall Thorac Surg

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The objective of this article was to review the evidence regarding multimodal analgesia drugs and regional block techniques in the context of thoracic surgery, with a special focus on video-assisted thoracic surgery (VATS).Background: Despite advances in surgical technique and the increased use of minimally invasive surgery, postoperative pain after thoracic surgery is still significant, especially in the first two postoperative days.Inadequate pain control leads to a reduced rate of pulmonary recovery which can lead to atelectasis, hypoxemia and pneumonia and is significantly linked to an increased incidence of chronic postsurgical pain.However, the optimal analgesic protocol that allows adequate postoperative pain control and facilitates fast recovery of this population has yet to be determined.Methods: An extensive review of articles published between January 1980 and November 2020 using different combinations of search terms that were relevant to the topic was conducted using PubMed search engine. All published full articles randomised controlled trials comparing the analgesic efficacy of a regional block or of a multimodal analgesic drug to a placebo in patients undergoing either thoracotomy or VATS were included in this review.Conclusions: Analgesic protocols in thoracic surgery must take into consideration the surgery that is being performed (VATS or thoracotomy) as well as patient's characteristics. Regional blocks are highly effective at providing good postoperative pain control although their duration is limited. Various non opioid analgesic drugs have been evaluated in order to address the various pain generators that cause postoperative pain after thoracic surgery, although none has become a clinical standard. Using a combined multimodal and regional analgesic protocol could improve postoperative pain control and decrease the use of parenteral opioids and their unwanted side effects. Recommendations on multimodal analgesic protocols are given based on the literature.

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Section: Part 3: Postoperative Isp In Thoracic Surgerymentioning

confidence: 99%

Perioperative pain management for thoracic surgery: a narrative review of the literature

Clairoux¹,

Issa²,

Bélanger³

et al. 2023

Curr Chall Thorac Surg

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“…While gabapentin is effective in prevention of shoulder pain after abdominal surgeries [29], it was not effective in treatment of postthoracotomy IPS, even as preemptive analgesia [19, 31]. Other popular molecules used for neuropathic pain (i.e., pregabalin) are regarded to be effective for treatment of ISP by other authors [27, 30].…”

Section: Treatmentsmentioning

confidence: 99%

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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“…Ipsilateral shoulder pain (ISP) is a common complication to thoracic surgery with an incidence between 37-97% depending on the study population and type of thoracic surgery (1)(2)(3)(4). In many cases, the pain resolves or minimizes after the first few days, but has been reported to last up to 4 days and becomes chronic in a subset of patients (5,6). The cause of ISP is multifactorial and involves a visceral component originating from irritation of the diaphragm and mediastinal pleura, mediated via the phrenic nerve, and a somatic component originating from the shoulder, caused by strain during surgery and positioning (7)(8)(9)(10).…”

mentioning

confidence: 99%

Treatment of ipsilateral shoulder pain after thoracic surgery—time for comparative studies?

Blichfeldt-Eckhardt

Toft

2019

J. Thorac. Dis.

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Post-thoracotomy shoulder pain and gabapentin: a tale of two enigmas

Cited by 5 publications

References 15 publications

Perioperative pain management for thoracic surgery: a narrative review of the literature

Perioperative pain management for thoracic surgery: a narrative review of the literature

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

Treatment of ipsilateral shoulder pain after thoracic surgery—time for comparative studies?

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