Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-28T00:01:17.790Z Has data issue: false hasContentIssue false
  • English
  • Français

Ipsilateral shoulder pain after thoracotomy surgery: a prospective, randomized, double-blind, placebo-controlled evaluation of the efficacy of infiltrating the phrenic nerve with 0.2%wt/vol ropivacaine

Published online by Cambridge University Press:  01 July 2007

G. Danelli ,
M. Berti ,
A. Casati ,
A. Bobbio ,
D. Ghisi ,
R. Mele ,
E. Rossini  and
G. Fanelli
G. Danelli
Affiliation:
University of Parma, Department of Anaesthesia and Pain Therapy, Ospedale Maggiore di Parma, Parma, Italy
M. Berti
Affiliation:
University of Parma, Department of Anaesthesia and Pain Therapy, Ospedale Maggiore di Parma, Parma, Italy
A. Casati*
Affiliation:
University of Parma, Department of Anaesthesia and Pain Therapy, Ospedale Maggiore di Parma, Parma, Italy
A. Bobbio
Affiliation:
University of Parma, Department of Thoracic Surgery, Ospedale Maggiore di Parma, Parma, Italy
D. Ghisi
Affiliation:
University of Parma, Department of Anaesthesia and Pain Therapy, Ospedale Maggiore di Parma, Parma, Italy
R. Mele
Affiliation:
University of Parma, Department of Anaesthesia and Pain Therapy, Ospedale Maggiore di Parma, Parma, Italy
E. Rossini
Affiliation:
University of Parma, Department of Anaesthesia and Pain Therapy, Ospedale Maggiore di Parma, Parma, Italy
G. Fanelli
Affiliation:
University of Parma, Department of Anaesthesia and Pain Therapy, Ospedale Maggiore di Parma, Parma, Italy
*
Correspondence to: Andrea Casati, Department of Anaesthesia and Pain Therapy, University of Parma, Ospedale Maggiore di Parma, Via Gramsci, 14 – 43100 Parma, Italy. E-mail: [email protected]; Tel: +39 0521 702161; Fax: +39 0521 984735
Get access

Summary

Background

The aim of this prospective, randomized, double-blind, placebo-controlled study was to evaluate the efficacy of phrenic nerve infiltration with ropivacaine 0.2% on the incidence and severity of ipsilateral shoulder pain after thoracotomy in patients receiving continuous thoracic epidural analgesia.

Methods

Fifty ASA physical status II–III patients, receiving thoracic epidural analgesia for post-thoracotomy pain, were randomly allocated to receive infiltration of the ipsilateral phrenic nerve with either ropivacaine 0.2% 10 mL (ropivacaine, n = 25), or saline 0.9% (control, n = 25) just before lung expansion and chest closure. A blinded observer recorded the incidence and severity of ipsilateral shoulder pain 6, 12, 24, 36 and 48 h after surgery. Postoperative respiratory function was also evaluated with blood gas analyses.

Results

The cumulative incidences of ipsilateral shoulder pain during the first 24 h after surgery were 8/25 in the ropivacaine and 16/25 in the control groups (P = 0.047), with median (range) onset times for shoulder pain of 2 (2–24) h with ropivacaine and 0.5 (0.5–24) h in controls (P = 0.005). No differences were reported on the second postoperative day. The areas under the curves of the amount of pain over time were 0 (0–2760) mm h for the ropivacaine and 350 (0–1900) mm h for the control groups (P = 0.06). Postoperatively, similar reductions in indices of oxygenation were observed in both groups.

Conclusions

Phrenic nerve infiltration with ropivacaine 0.2% 10 mL reduced the incidence and delayed the onset of ipsilateral shoulder pain during the first 24 h after open lung resection, with no clinically relevant effects on respiratory function.

Keywords

THORACIC SURGERYEPIDURAL ANAESTHESIA, thoracicPHRENIC NERVEROPIVACAINESHOULDER PAIN
Type
EACTA Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 7 , July 2007 , pp. 596 - 601
Copyright
Copyright © European Society of Anaesthesiology 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Ballantyne, JC, Carr, DB, de Ferranti, S et al. . The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomised, controlled trials. Anesth Analg 1998; 86: 598–612.Google Scholar
2.Della Rocca, G, Coccia, C, Pompei, L et al. . Post-thoracotomy analgesia: epidural vs intravenous morphine continuous infusion. Minerva Anestesiol 2002; 68: 681–693.Google ScholarPubMed
3.Burgess, FW, Anderson, DM, Colonna, D et al. . Ipsilateral shoulder pain following thoracic surgery. Anesthesiology 1993; 78: 365–368.CrossRefGoogle ScholarPubMed
4.Scawn, ND, Pennefather, SH, Soorae, A et al. . Ipsilateral shoulder pain after thoracotomy with epidural analgesia: the influence of phrenic nerve infiltration with lidocaine. Anesth Analg 2001; 93: 260–264.CrossRefGoogle ScholarPubMed
5.Ng, KP, Chow, YF. Brachial plexus block for ipsilateral shoulder pain after thoracotomy. Anaesth Intens Care 1997; 25: 74–76.CrossRefGoogle ScholarPubMed
6.Tan, N, Agnew, NM, Scawn, ND et al. . 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. Anesth Analg 2002; 94: 199–202.CrossRefGoogle ScholarPubMed
7.Pennefather, SH, Akrofi, ME, Kendall, JB et al. . Double-blind comparison of intrapleural saline and 0.25% bupivacaine for ipsilateral shoulder pain after thoracotomy in patients receiving thoracic epidural analgesia. Br J Anaesth 2005; 94: 234–238.CrossRefGoogle ScholarPubMed
8.Casati, A, Mascotto, G, Iemi, K, Nzepa-Batonga, J, De Luca, M. Epidural block does not worsen patient oxygenation during one-lung ventilation for lung resection surgery performed under isoflurane general anaesthesia. Eur J Anaesthesiol 2005; 22: 363–368.CrossRefGoogle ScholarPubMed
9.Mac, TB, Girard, F, Chouinard, P et al. . Acetaminophen decreases early post-thoracotomy ipsilateral shoulder pain in patients with thoracic epidural analgesia: a double-blind placebo-controlled study. J Cardiothorac Vasc Anesth 2005; 19: 475–478.CrossRefGoogle ScholarPubMed
10.Browner, WS, Black, D, Newman, B. Estimating sample size and power. In: Hulley SB, Cummings SR (eds). Designing Clinical Research – An Epidemiologic Approach. Baltimore, USA: Williams & Wilkins, 1988: 139–150.Google Scholar
11.Barak, M, Ziser, A, Katz, Y. Thoracic epidural local anesthetics are ineffective in alleviating post-thoracotomy ipsilateral shoulder pain. J Cardiothoracic Vasc Anesth 2004; 18: 458–460.CrossRefGoogle ScholarPubMed
12.Bic Mac, T, Girard, F, Chouinard, P et al. . Acetaminophen decreases early postthoracotomy ipsilateral shoulder pain in patients with thoracic epidural analgesia: a double-blind placebo-controlled study. J Cardiothoracic Vasc Anesth 2005; 19: 475–478.CrossRefGoogle Scholar
13.Casati, A, Putzu, M. Bupivacaine, levobupivacaine and ropivacaine: are they clinically different? Best Pract Res Clin Anaesthesiol 2005; 19: 247–268.CrossRefGoogle ScholarPubMed
14.Abrahams, PH, Hutchings, RT, JrMarks, SC. McMinn’s Color Atlas of Human Anatomy. Barcelona, Spain: Mosby Int, 1998: 164–185.Google Scholar
15.Mascotto, G, Bizzarri, M, Messina, M et al. . A prospective, randomised, controlled evaluation of the preventive effects of peep on patient oxygenation during one-lung ventilation. Eur J Anaesthesiol 2003; 20: 704–710.Google Scholar
16.Urmey, WF, Talts, KH, Sharrock, NE. One hundred percent incidence of hemidiaphragmatic paresis associated with interscalene brachial plexus anesthesia as diagnosed by ultrasonography. Anesth Analg 1991; 72: 498–503.Google Scholar
17.Casati, A, Fanelli, G, Cedrati, V et al. . Pulmonary function changes after interscalene brachial plexus anesthesia with 0.5% and 0.75% ropivacaine: a double-blinded comparison with 2% mepivacaine. Anesth Analg 1999; 88: 587–592.CrossRefGoogle ScholarPubMed
18.Borgeat, A, Perschak, H, Bird, P, Hodler, J, Gerber, C. Patient-controlled interscalene analgesia with ropivacaine 0.2% versus patient-controlled intravenous analgesia after major shoulder surgery: effects on diaphragmatic and respiratory function. Anesthesiology 2000; 92: 102–108.CrossRefGoogle ScholarPubMed