A Randomized Study Comparing the Incidence of Postoperative Pain After Phrenic Nerve Infiltration Vs Nonphrenic Nerve Infiltration During Thoracotomy

Krishnamoorthy, Bhuvaneswari; Critchley, William R.; Soon, Sing Yang; Birla, Rashmi; Begum, Z.; Nair, Janesh; Devan, Nehru; Mohan, Ram S.; Fildes, James E.; Morris, Jonathan; Fullwood, Catherine; Krysiak, Piotr; Malagon, Ignacio

doi:10.1053/j.semtcvs.2018.11.014

Cited by 4 publications

(16 citation statements)

References 14 publications

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“…Therefore, effective and safe intervention for ISP management is imperative. The occurrence of ISP after thoracic surgery relates to a transection of the major bronchus [ 14 ], referred pain from an irritation of diaphragmatic pleura, pericardium, and mediastinum via the phrenic nerve [ 1 , 5 , 6 , 12 , 13 , 16 ], straining of muscles around the shoulder joint during lateral decubitus position [ 17 , 18 ], and pleural irritation from the chest tube [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Introductionmentioning

confidence: 99%

“…Various types of PNB, such as phrenic nerve infiltration (PNI) [ 1 , 5 , 6 , 12 , 13 , 16 , 21 ] or PNB under a supraclavicular approach [ 22 ], could significantly reduce the incidence and severity of ISP. PNI with long-acting local anesthetics is preferable to lidocaine for relieving ISP up to 24 h after surgery [ 22 ].…”

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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“…RCTs have called a halt to many treatments shown to not benefit patients [1], but they are an exacting discipline. Krishnamoorthy and colleagues [2] call for further research, (as authors often do) but a lot is known already and some of remaining uncertainties are amenable to observational study. [3] What is the cause of shoulder pain after thoracotomy?…”

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confidence: 99%

“…"A size 28Fg chest tube was placed as an apical drain according to our local surgeon's practice." [2] Perhaps the position of the apostrophe provides a clue; pleural drainage is such a personal matter [7] that there may have been deviations from protocol. Why not review the radiographs and count the drains and their position?…”

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confidence: 99%

“…In a randomised trial of stopping or continuing aspirin before coronary surgery, blood and urine samples showed 99% compliance providing mechanistic verification of the empirical findings of the RCT. [8] The authors state that diaphragmatic paralysis due to phrenic nerve block "has not yet been proven" [2] It clearly has. A PubMed search for [(phrenic nerve block) OR (phrenic nerve infiltration)] AND [(diaphragm*) AND (paralysis)] found 12 papers, mainly reporting inadvertent paralysis of the diaphragm with brachial plexus block.…”

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confidence: 99%

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