Suprascapular Nerve Block for Ipsilateral Shoulder Pain After Thoracotomy with Thoracic Epidural Analgesia: A Double-Blind Comparison of 0.5% Bupivacaine and 0.9% Saline

Tan, Ngukhoon; Agnew, Neil McK.; Scawn, N. D. A.; Pennefather, Stephen H.; Chester, Michael R.; Russell, G. N.

doi:10.1213/00000539-200201000-00038

Cited by 74 publications

(28 citation statements)

References 9 publications

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“…The 86% prevalence of PTSP, amongst all patients in this study, is within the 60% to 97% range of that reported in recent literature. [3][4][5][6] This confirms that most post-thoracotomy patients will experience shoulder pain in the early postoperative period.…”

Section: Discussionsupporting

confidence: 57%

“…Patients complain of a constant, moderate to severe, aching pain, in the posterior deltoid and in the suprascapular region, ipsilateral to the surgery. [1][2][3][4][5][6] The most plausible mechanisms, amongst several proposed to explain the occurrence of post-thoracotomy shoulder pain (PTSP), 2,7,8 appear to be pain referred from an irritation of the pericardium or pleural surfaces. 5 Different pharmacological agents have been used to alleviate PTSP, but few of these modalities have proven attractive, notably because of their side effects and their relatively short half-life.…”

mentioning

confidence: 99%

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Gabapentin does not reduce post-thoracotomy shoulder pain: a randomized, double-blind placebo-controlled study

Huot

Chouinard

Girard

et al. 2008

Can J Anesth/J Can Anesth

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Purpose: Despite adequate epidural analgesia, up to 97% of patients undergoing thoracotomy experience ipsilateral shoulder pain. In this setting, this study evaluated the safety and the efficacy of pre-emptive gabapentin. Methods:A double-blind, placebo-controlled study was undertaken in 51 patients randomized into two groups. Two hours before surgery, 23 patients received gabapentin 1200 mg po (Group G), and 28 patients received placebo (Group P). Shoulder pain and postoperative pain, at the surgical site, were monitored every four hours for 24 hr, using a numerical rating scale. Subcutaneous hydromorphone was administered for rescue analgesia against shoulder pain. Results:Forty-four patients complained of shoulder pain (prevalence of 86%). Demographic and surgical data were similar between the two groups. There were no significant differences in the total cumulative doses of hydromorphone administered at eight, 16, and 24 hr, nor were there differences in individual numerical rating scale scores for shoulder pain. The groups were similar with respect to the degree of pain at the surgical site. The frequency of side effects between groups at corresponding time intervals was also similar, with the exception of sedation. At four hours, the incidence of sedation scores > 1 was greater in Group G (21/23 patients), compared to Group P (18/28 patients; P = 0.025). In contrast, by 24 hr, 5/18 patients in Group P had sedation scores > 1, compared to 0/28 patients in Group G (P = 0.05). Conclusion:Pre-emptively administered gabapentin, 1200 mg, does not reduce the incidence, or the severity, of post-thoracotomy shoulder pain in patients receiving thoracic epidural analgesia.

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Section: Discussionsupporting

confidence: 57%

mentioning

confidence: 99%

Gabapentin does not reduce post-thoracotomy shoulder pain: a randomized, double-blind placebo-controlled study

Huot

Chouinard

Girard

et al. 2008

Can J Anesth/J Can Anesth

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“…Intrapleural bupivacaine did not provide effective pain relief (56). Superficial cervical plexus or interscalene brachial plexus blocks effectively reduced localized shoulder pain in some patients (57;58), whereas suprascapular nerve block was not helpful (59). Phrenic nerve block via intraoperative infiltration of the periphrenic fat pad with lidocaine reduced the incidence of shoulder pain from 85% to 33% and lowered overall pain scores (60).…”

Section: Shoulder Painmentioning

confidence: 99%

Postthoracotomy Pain Management Problems

Gerner

2008

Anesthesiology Clinics

220

130

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SynopsisPain after thoracotomy is very severe, probably the most severe pain experienced after surgery. It is also unique as this pain state has multiple implications, including respiratory failure due to splinting; inability to clear secretions by effective coughing, with resulting pneumonia; and facilitation of the often incapacitating chronic pain: the post-thoracotomy pain syndrome. Thoracic epidural analgesia has greatly improved the pain experience and its consequences and has been considered the 'gold standard' for pain management after thoracotomy. This view has recently been challenged by the use of paravertebral nerve blocks. Nevertheless, severe ipsilateral shoulder pain and the prevention of the post-thoracotomy pain syndrome remain the most important challenges for post-thoracotomy pain management.

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“…1 A suprascapular nerve block (SSNB) is an effective method for the treatment of certain shoulder disorders such as adhesive capsulitis, rheumatoid arthritis, calcifying tendinitis, and post-cerebrovascular accident. [2][3][4] The procedure has been increasingly used in severe pain control and postoperative analgesia after shoulder surgery, [4][5][6][7] as other therapeutic options such as anti-infl ammatory drugs and intra-articular steroid injections have their limitations, mainly in the elderly population, which has many comorbidities. 4,8 The SSNB is a safe, simple, inexpensive procedure, applicable to the majority of physicians working with pain management, 9 in addition to being well tolerated even by patients with several pathologies that affect the shoulder region.…”

Section: Introductionmentioning

confidence: 99%

“…10 Another SSNB use would be in anesthesiology, regarding locoregional blocks. 5,6,11 Although effi cient regarding its effects, several authors have shown technical modifi cations to the original SSNB since it was fi rst published, such as the needle insertion site, drug volume, and type and access used, as well as the use of additional equipment to perform the procedure.…”

Section: Introductionmentioning

confidence: 99%

Bloqueio do nervo supraescapular: procedimento importante na prática clínica. Parte II

Fernandes¹,

Barbosa²,

Sousa³

et al. 2012

Rev. Bras. Reumatol.

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The suprascapular nerve block is a reproducible, reliable, and extremely effective treatment method in shoulder pain control. This method has been widely used by professionals in clinical practice such as rheumatologists, orthopedists, neurologists, and pain specialists in the treatment of chronic diseases such as irreparable rotator cuff injury, rheumatoid arthritis, stroke sequelae, and adhesive capsulitis, which justifi es the present review (Part II). The objective of this study was to describe the techniques and complications of the procedure described in the literature, as the fi rst part reported the clinical indications, drugs, and volumes used in single or multiple procedures. We present in details the accesses used in the procedure: direct and indirect, anterior and posterior, lateral and medial, upper and lower. There are several options to perform suprascapular nerve block. Although rare, complications can occur. When properly indicated, this method should be considered.

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Suprascapular Nerve Block for Ipsilateral Shoulder Pain After Thoracotomy with Thoracic Epidural Analgesia: A Double-Blind Comparison of 0.5% Bupivacaine and 0.9% Saline

Cited by 74 publications

References 9 publications

Gabapentin does not reduce post-thoracotomy shoulder pain: a randomized, double-blind placebo-controlled study

Gabapentin does not reduce post-thoracotomy shoulder pain: a randomized, double-blind placebo-controlled study

Postthoracotomy Pain Management Problems

Bloqueio do nervo supraescapular: procedimento importante na prática clínica. Parte II

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