Postoperative Pain Management and the Incidence of Ipsilateral Shoulder Pain After Thoracic Surgery at an Australian Tertiary-Care Hospital: A Prospective Audit

Hodge, Anthony; Rapchuk, Ivan L.; Gurunathan, Usha

doi:10.1053/j.jvca.2020.07.078

Cited by 7 publications

(9 citation statements)

References 41 publications

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“…ISP is a common postoperative complication after thoracic surgery, with an incidence of 42-85% (11,30). To date, the specific etiology of ISP remains unknown; therefore, management of ISP is challenging.…”

Section: Discussionmentioning

confidence: 99%

“…A longitudinal observational prospective cohort study found a significant correlation between postoperative muscle dysfunction of shoulder skeletal muscle and VATS, and this dysfunction still existed at 1 month postoperatively (5). Previous studies related to ISP have focused on open thoracic surgery (11), and explanations for the cause of pain have mostly been limited to surgical trauma, such as surgically induced nerve pull pain (3)(4)(5), muscle damage, and postoperative chest drain irritation (13); hence, the corresponding management measures for ISP are symptomatic analgesic treatments, such as nerve blocks (14)(15)(16)(17) and the application of analgesics (25-28). A randomized double-blind study of phrenic and SNB on the occurrence of ISP after thoracic surgery showed a significant reduction in shoulder pain in the group by the application of 2% lidocaine for phrenic nerve block (5).…”

Section: Discussionmentioning

confidence: 99%

“…A few patients can experience chronic pain 1 year postoperatively (8). The incidence of ISP in thoracic surgery ranges between 21 and 97% (4,9,10) and recent literature indicates a prevalence rate of 42-85% (11). The incidence of ISP after single-operator port thoracoscopy is ∼20%, which is significantly lower than the incidence of ISP after open thoracic surgery (10).…”

Section: Introductionmentioning

confidence: 99%

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Effect of Upper Arm Position Changes on the Occurrence of Ipsilateral Shoulder Pain After Single-Operator Port Thoracoscopy

Zhang

Liu

et al. 2022

Front. Surg.

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BackgroundThe aim of this study was to explore the factors associated with the occurrence of ISP after VATS to reduce the incidence of ISP and improve patients' quality of life.MethodsThe data of patients were collected between June 2020 and August 2020 in the Department of Lung Cancer Surgery, Tianjin Medical University General Hospital. The angle of upper arm was measured intraoperatively. The patient's postoperative shoulder function was quantified using the Constant-Murley shoulder function rating score. The proportional hazards model was applied to identify multiple influence factors.ResultsA total of 140 eligible patients met criteria. At postoperative day 3, only the age influenced patients' shoulder pain. At postoperative day 14, univariate and multivariate logistic regression analyses showed that age (odds ratio [OR]: 1.098 [1.046-1.152]; P < 0.001) and upper arm Angle A (OR: 1.064 [1.011-1.121]; P = 0.018) were independent risk factors for low shoulder function scores. However, height was its protective factor (OR: 0.923 [0.871-0.977]; P = 0.006). At postoperative day 42, univariate and multivariate logistic regression analyses showed that age (OR: 1.079 [1.036-1.124]; P < 0.001) was a risk factor for low shoulder function scores, and height (OR: 0.933 [0.886-0.983]; P = 0.009) was its protective factor. In contrast, upper arm Angle B was not statistically associated with low shoulder function scores (P>0.05). In addition, the reduction in ipsilateral Shoulder scores after surgery was higher in patients with more than 113° of angle A (P = 0.025).ConclusionISP was closely related to the angle of anterior flexion of the upper arm on the patient's operative side intraoperatively. The increase in the degree of postoperative shoulder injury is more pronounced for an anterior flexion angle of >113°. Therefore, we recommend that the angle of anterior flexion of the upper extremity should be <113° intraoperatively.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of Upper Arm Position Changes on the Occurrence of Ipsilateral Shoulder Pain After Single-Operator Port Thoracoscopy

Zhang

Liu

et al. 2022

Front. Surg.

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“…Other drugs such as gabapentin and pregabalin have not proved to be beneficial (53,82). Intraoperative phrenic nerve blocks, through local anesthetic infiltration of the diaphragmatic fat pad by the surgeon, are very efficient in reducing the incidence and severity of ISP after both VATS and thoracotomy (73,(83)(84)(85)(86). The analgesic duration of this block can be extended to 48 h with the use of long-acting local anesthetics, which are sufficient to provide analgesia when ISP is most severe, without significantly affecting postoperative respiratory function tests (83,85,87).…”

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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“…Ipsilateral shoulder pain (ISP) is a common complication following thoracic surgery. Its incidence varies between 21% and 97% [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. The level of ISP is not effectively relieved by thoracic epidural analgesia and systemic opioids [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Phrenic Nerve Block and Suprascapular Nerve Block in Amelioration of Ipsilateral Shoulder Pain after Thoracic Surgery: A Systematic Review and Network Meta-Analysis

et al. 2023

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Background and Objectives: Ipsilateral shoulder pain (ISP) is a common complication after thoracic surgery. Severe ISP can cause ineffective breathing and impair shoulder mobilization. Both phrenic nerve block (PNB) and suprascapular nerve block (SNB) are anesthetic interventions; however, it remains unclear which intervention is most effective. The purpose of this study was to compare the efficacy and safety of PNB and SNB for the prevention and reduction of the severity of ISP following thoracotomy or video-assisted thoracoscopic surgery. Materials and methods: Studies published in PubMed, Embase, Scopus, Web of Science, Ovid Medline, Google Scholar and the Cochrane Library without language restriction were reviewed from the publication’s inception through 30 September 2022. Randomized controlled trials evaluating the comparative efficacy of PNB and SNB on ISP management were selected. A network meta-analysis was applied to estimate pooled risk ratios (RRs) and weighted mean difference (WMD) with 95% confidence intervals (CIs). Results: Of 381 records screened, eight studies were eligible. PNB was shown to significantly lower the risk of ISP during the 24 h period after surgery compared to placebo (RR 0.44, 95% CI 0.34 to 0.58) and SNB (RR 0.43, 95% CI 0.29 to 0.64). PNB significantly reduced the severity of ISP during the 24 h period after thoracic surgery (WMD –1.75, 95% CI –3.47 to –0.04), but these effects of PNB were not statistically significantly different from SNB. When compared to placebo, SNB did not significantly reduce the incidence or severity of ISP during the 24 h period after surgery. Conclusion: This study suggests that PNB ranks first for prevention and reduction of ISP severity during the first 24 h after thoracic surgery. SNB was considered the worst intervention for ISP management. No evidence indicated that PNB was associated with a significant impairment of postoperative ventilatory status.

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Postoperative Pain Management and the Incidence of Ipsilateral Shoulder Pain After Thoracic Surgery at an Australian Tertiary-Care Hospital: A Prospective Audit

Cited by 7 publications

References 41 publications

Effect of Upper Arm Position Changes on the Occurrence of Ipsilateral Shoulder Pain After Single-Operator Port Thoracoscopy

Effect of Upper Arm Position Changes on the Occurrence of Ipsilateral Shoulder Pain After Single-Operator Port Thoracoscopy

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

Efficacy of Phrenic Nerve Block and Suprascapular Nerve Block in Amelioration of Ipsilateral Shoulder Pain after Thoracic Surgery: A Systematic Review and Network Meta-Analysis

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