Ipsilateral Shoulder Pain After Thoracotomy with Epidural Analgesia: The Influence of Phrenic Nerve Infiltration with Lidocaine

Scawn, N. D. A.; Pennefather, Stephen H.; Soorae, A S; Wang, Julian Y. Y.; Russell, G. N.

doi:10.1097/00000539-200108000-00004

Cited by 45 publications

(48 citation statements)

References 10 publications

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“…Two of the patients were treated with a variety of agents including nitrates and calcium channel blockers without any symptomatic relief. We believe that the midepigastric and chest pain radiating to the left shoulder and jaw reported by these patients is referred, secondary to irritation of the phrenic nerve [8][9][10]. Given that patients undergoing bariatric surgery are more prone to herniation of the gastric pouch through the diaphragmatic hiatus, it is likely this "phrenic pain" is provoked via rubbing of the gastric staple line on the left diaphragmatic parietal pleura.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Treatment of Atypical Presentations of Hiatal Hernia Following Bariatric Surgery

et al. 2009

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Bariatric surgery dramatically alters the normal stomach anatomy resulting in a significant incidence of hiatal hernia and gastroesophageal reflux disease. Although the majority of patients remain asymptomatic, many complain of severe heartburn refractory to medical management and additional highly atypical symptoms. Here, we describe the diagnosis and treatment regarding four cases of symptomatic hiatal hernia following bariatric surgery presenting with atypical symptoms in the University Hospital, USA. Four patients presented following laparoscopic Roux-en-Y gastric bypass or duodenal switch/pancreaticobiliary bypass (DS) with disabling and intractable midepigastric abdominal pain characterized as severe and radiating to the jaw, left shoulder, and midscapular area. The pain in all cases was described as paroxysmal and not necessarily associated with eating. All four patients also experienced nausea, vomiting, and failure to thrive at various intervals following laparoscopic bariatric surgery. Routine workup failed to produce any clear mechanical cause of these symptoms. However, complimentary use of multidetector CT and upper gastrointestinal contrast studies eventually revealed the diagnosis of hiatal hernia. Exploration identified the presence of a type I hiatal hernia in all four patients, with the stomach staple lines densely adherent to the diaphragm and parietal peritoneum. Operative intervention led to immediate and complete resolution of symptoms. The presence of a hiatal hernia following bariatric surgery can present with highly atypical symptoms that do not resolve without operative intervention. Recognition of this problem should lead to the consideration of surgery in cases where patients are dependent on artificial nutritional support and whose symptoms are poorly controlled with medication alone.

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Section: Discussionmentioning

confidence: 99%

Diagnosis and Treatment of Atypical Presentations of Hiatal Hernia Following Bariatric Surgery

et al. 2009

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“…Reported techniques for relieving shoulder pain apart from IV pain medications include stellate ganglion block [4], suprascapular nerve block [5], and phrenic nerve infiltration with local anesthetic at the site of the pericardial fat pad [2]. The lack of complete pain relief with a suprascapular nerve block suggests that mechanical distress of the shoulder is not the major player in the origin of this pain.…”

Section: Discussionmentioning

confidence: 99%

“…Reportedly 75% to 85% of thoracotomy patients develop ipsilateral shoulder pain postoperatively. This pain diminishes the benefits of a functional thoracic epidural [1,2]. Believed to be of multifactorial etiology, postthoracotomy shoulder pain can be extremely distressing to patients.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-guided interscalene block for postthoracotomy ipsilateral shoulder pain

Keith

Arora

Kumar

2008

Journal of Clinical Anesthesia

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“…After thoracotomy, patients typically report severe pain, which may limit respiratory function and impede postoperative recovery. Epidural catheters, local anesthetic infiltration, and nonsteroidal anti-inflammatory drugs (NSAIDs) are used to maximize analgesia [57,58]. Although acupuncture has been shown to reduce pain, acupuncture needles can potentially interfere with the surgical field and hamper epidural catheter placement, making acupuncture a poor choice for addressing post-thoracotomy pain.…”

Section: Post-thoracotomy Pain In Lung Cancer Patientsmentioning

confidence: 99%

Acupuncture Research at Memorial Sloan Kettering Cancer Center

Javdan

Cassileth

2015

Journal of Acupuncture and Meridian Studies

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Acupuncture may help treat specific cancer-related symptoms. Here, we summarize our clinical trials that sought to determine acupuncture's role in managing cancer-related symptoms. Trials have been conducted to determine acupuncture's ability to mitigate cancer-related symptoms including dyspnea, fatigue, xerostomia, lymphedema, hot flashes, postoperative ileus, pain and dysfunction after neck dissection, and postthoracotomy pain. Published studies indicate that acupuncture versus placebo acupuncture failed to reduce cancer-related dyspnea. Both true and sham acupuncture alleviated fatigue slightly, but no significant differences between groups emerged. Compared with sham acupuncture, our research showed that acupuncture significantly improved saliva production in patients with xerostomia and significantly reduced lymphedema patients' arm circumference in a pilot study. However, acupuncture failed to significantly reduce hot flashes and was no more successful than sham acupuncture in reducing postoperative ileus. Significant reductions in pain and dysfunction occurred in cancer patients after neck dissection. In a feasibility study, acupuncture was found to be acceptable to lung cancer patients and did not interfere with standard postoperative care. In summary, acupuncture is a potential candidate for the treatment of some important cancer-related symptoms. Large clinical trials and research to investigate mechanistic pathways are warranted.

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Ipsilateral Shoulder Pain After Thoracotomy with Epidural Analgesia: The Influence of Phrenic Nerve Infiltration with Lidocaine

Cited by 45 publications

References 10 publications

Diagnosis and Treatment of Atypical Presentations of Hiatal Hernia Following Bariatric Surgery

Diagnosis and Treatment of Atypical Presentations of Hiatal Hernia Following Bariatric Surgery

Ultrasound-guided interscalene block for postthoracotomy ipsilateral shoulder pain

Acupuncture Research at Memorial Sloan Kettering Cancer Center

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