Ipsilateral Shoulder Pain After Thoracotomy with Epidural Analgesia: The Influence of Phrenic Nerve Infiltration with Lidocaine
| Autor: | Glenn N. Russell, Stephen H. Pennefather, Julian Y. Y. Wang, Nigel D. A. Scawn, Ajaib Soorae |
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| Rok vydání: | 2001 |
| Předmět: |
Male
medicine.medical_specialty Lidocaine medicine.drug_class medicine.medical_treatment Fat pad law.invention Double-Blind Method Randomized controlled trial Shoulder Pain law Humans Medicine Thoracotomy Anesthetics Local Saline Aged Phrenic nerve business.industry Local anesthetic Middle Aged Surgery Analgesia Epidural Phrenic Nerve Anesthesiology and Pain Medicine Anesthesia Female business Complication medicine.drug |
| Zdroj: | Anesthesia & Analgesia. 93:260-264 |
| ISSN: | 0003-2999 |
| Popis: | UNLABELLED Patients receiving effective thoracic epidural analgesia for postthoracotomy pain may still complain of severe ipsilateral shoulder pain. The etiology of this pain is unclear. In this randomized, double-blinded, placebo-controlled study, we investigated the effect of phrenic nerve infiltration with lidocaine or saline on postoperative shoulder pain in 48 patients. After completion of a lung resection, patients received either 10 mL of 1% lidocaine or 10 mL of 0.9% saline infiltrated into the periphrenic fat pad at the level of the diaphragm. Shoulder pain was experienced by 33% of patients receiving lidocaine, compared with 85% of patients receiving saline (P < 0.008). Overall pain scores were lower with lidocaine (P < 0.05). PaCO(2) values were not significantly higher with lidocaine in the first 2 h. We conclude that pain transmitted via the phrenic nerve and referred to the shoulder is the most likely explanation for the ipsilateral shoulder pain experienced by patients receiving epidural analgesia for postthoracotomy pain. IMPLICATIONS Ipsilateral shoulder pain after thoracotomy is common and may be severe, even in the presence of a functioning thoracic epidural. We have shown that infiltration of the phrenic nerve with local anesthetic significantly and safely reduces this shoulder pain, potentially allowing the ideal goal of a pain-free thoracotomy. |
| Databáze: | OpenAIRE |
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