Double-blind comparison of intrapleural saline and 0.25% bupivacaine for ipsilateral shoulder pain after thoracotomy in patients receiving thoracic epidural analgesia

Pennefather, Stephen H.; Akrofi, M.; Kendall, John; Russell, G. N.; Scawn, N. D. A.

doi:10.1093/bja/aei030

Cited by 50 publications

(46 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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: 55%

“…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%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 55%

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

View full text Add to dashboard Cite

show abstract

“…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).…”

Section: Shoulder Painmentioning

confidence: 95%

Postthoracotomy Pain Management Problems

Gerner

2008

Anesthesiology Clinics

226

130

View full text Add to dashboard Cite

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.

show abstract

“…As regards concentration, 0.25% bupivacaine showed to be effective in cholecystectomies when compared to a similar volume in concentrations of 0.375% and 0.5% Most studies show lesser worsening in respiratory function after the intrapleural block 12,34 ; others also affirm that the ventilatory parameters cannot be used as predictors for postoperative complications 35 . What is known is that, clinically, the intrapleural block does not determine adverse effects in the respiratory muscle function and, contrarily, it becomes beneficial due to reduced postoperative pain…”

Section: Resultsmentioning

confidence: 99%

Intrapleural analgesia after endoscopic thoracic sympathectomy

et al. 2011

View full text Add to dashboard Cite

Brazil. Advisor and critical revision. ABSTRACT PURPOSE:To compare analgesia traditionally used for thoracic sympathectomy to intrapleural ropivacaine injection in two different doses. METHODS: Twenty-four patients were divided into three similar groups, and all of them received intravenous dipyrone. Group A received intravenous tramadol and intrapleural injection of saline solution. Group B received intrapleural injection of 0.33% ropivacaine, and Group C 0.5% ropivacaine. The following aspects were analyzed: inspiratory capacity, respiratory rate and pain. Pain was evaluated in the immediate postoperative period by means of the visual analog scale and over a one-week period. RESULTS: In Groups A and B, reduced inspiratory capacity was observed in the postoperative period. In the first postoperative 12 hours, only 12.5% of the patients in Groups B and C showed intense pain as compared to 25% in Group A. In the subsequent week, only one patient in Group A showed mild pain while the remainder reported intense pain. In Group B, half of the patients showed intense pain, and in Group C, only one presented intense pain. CONCLUSION: Intrapleural analgesia with ropivacaine resulted in less pain in the late postoperative period with better analgesic outcomes in higher doses, providing a better ventilatory pattern. Keywords: Intrapleural Analgesia. Sympathectomy. Thoracoscopy. RESUMO OBJETIVO:Comparar a analgesia tradicionalmente utilizada para simpatectomia videotoracoscópica à injeção intrapleural de ropivacaína em duas doses diferentes. MÉTODOS: Vinte e quatro pacientes foram distribuídos em três grupos semelhantes, e todos eles receberam dipirona endovenosa. O grupo A recebeu tramadol endovenoso e injeção intrapleural de solução salina. O grupo B recebeu injeção intrapleural de ropivacaína a 0,33%, e Grupo C ropivacaína a 0,5%. Os aspectos analisados foram: capacidade inspiratória, freqüência respiratória e dor. A dor foi avaliada no período pós-operatório por meio da escala visual analógica e durante o período de uma semana. RESULTADOS: Nos grupos A e B, a redução da capacidade inspiratória foi observada no período pós-operatório. Nas primeiras 12 horas de pós-operatório, apenas 12,5% dos pacientes nos grupos B e C apresentaram dor intensa em comparação a 25% no Grupo A. Na semana seguinte, apenas um paciente do grupo A apresentou dor leve, enquanto o restante relatou dor intensa. No Grupo B, metade dos pacientes apresentou dor intensa, e no Grupo C, apenas um apresentou intensa dor. CONCLUSÃO: A analgesia intrapleural com ropivacaína resultou em menos dor no pós-operatório tardio com os melhores resultados analgésicos nas doses mais altas, proporcionando um melhor padrão ventilatório. Descritores: Analgesia Intrapleural. Simpatectomia. Toracoscopia. Intrapleural analgesia after endoscopic thoracic sympathectomyActa Cirúrgica Brasileira -Vol. 26 (6) 5011 -509

show abstract

Double-blind comparison of intrapleural saline and 0.25% bupivacaine for ipsilateral shoulder pain after thoracotomy in patients receiving thoracic epidural analgesia

Abstract: Intrapleural administration of 40 ml of bupivacaine 0.25% does not provide effective pain relief for ipsilateral post-thoracotomy shoulder pain.

Cited by 50 publications

References 25 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

Intrapleural analgesia after endoscopic thoracic sympathectomy

Contact Info

Product

Resources

About