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

Postthoracotomy Pain Management Problems

“…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). Phrenic nerve block via intraoperative infiltration of the periphrenic fat pad with lidocaine reduced the incidence of shoulder pain from 85% to 33% and lowered overall pain scores (60). Ropivacaine 0.2% reduced the incidence and delayed the onset of shoulder pain for the first 24 hours postoperatively with no adverse effect on respiratory function (61).…”

Post-thoracotomy shoulder pain and gabapentin: a tale of two enigmas

“…These findings are consistent with other case reports. 7 As well, while Scawn et al 8 and Danelli et al 9 demonstrated a significant reduction in post-thoracotomy SP, following injection of local anesthetic into the peri-phrenic nerve fat pad, a significant number of their patients continued to experience post-thoracotomy SP. Therefore, there is suggestion that post-thoracotomy SP, in a subset of patients, may originate from sources other than the phrenic nerve.…”

“…Regional techniques using interscalene or stellate ganglion block have relieved post-thoracotomy SP. Case reports concerning direct blockade of the phrenic nerve 7 as well as randomized controlled trials of local anesthetic infiltration of the phrenic nerve, 8,9 have been shown effective in reducing post-thoracotomy SP. Barak et al 10 conducted a randomized controlled study comparing interscalene block vs intravenous diclofenac, for relief of postthoracotomy SP, and demonstrated rapid relief of post-thoracotomy SP in the interscalene block group.…”

“…Les techniques d'anesthésie régionale faisant usage de blocs interscalénique ou du ganglion stellaire ont soulagé les douleurs à l'épaule à la suite d'une thoracotomie. Des présentations de cas traitant de blocs directs du nerf phrénique 7 ainsi que des études randomisées contrôlées d'infiltration d'anesthésiant local au site du nerf phrénique 8,9 ont démontré leur efficacité pour réduire les douleurs à l'épaule post-thoracotomie. Barak et coll.…”

“…7 En outre, bien que Scawn et coll. 8 et Danelli et coll. 9 aient montré une réduction considérable de la douleur à l'épaule post-thoracotomie à la suite d'une injection d'anesthésique local dans le panicule adipeux autour du nerf phrénique, un nombre significatif de leurs patients a continué à ressentir une douleur à l'épaule post-thoracotomie.…”