Myofascial Involvement of Supra- and Infraspinatus Muscles Contributes to Ipsilateral Shoulder Pain After Muscle-Sparing Thoracotomy and Video-Assisted Thoracic Surgery

Ohmori, Aki; Iranami, Hiroshi; Fujii, Keisuke; Yamazaki, Akinori; Doko, Yukari

doi:10.1053/j.jvca.2013.03.037

Cited by 21 publications

(14 citation statements)

References 17 publications

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“…One study has reported a greater risk of shoulder pain after thoracotomy but in that study, thoracotomies were mostly large lung resections (lobectomy or pneumonectomy) which have consistently been associated with the development of ipsilateral shoulder pain while the thoracoscopic operations were almost all minor lung resections (segmentectomy, wedge resection, biopsy). Another study found no difference in the incidence of shoulder pain between thoracotomy and VATS . This is in line with the multivariate logistic regression analysis of the patients in our study, which found that surgical approach was not associated with the incidence of shoulder pain.…”

Section: Discussionsupporting

confidence: 92%

A randomised, controlled, double-blind trial of ultrasound-guided phrenic nerve block to prevent shoulder pain after thoracic surgery

et al. 2016

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Moderate to severe ipsilateral shoulder pain is a common complaint following thoracic surgery. In this prospective, parallel-group study at Odense University Hospital, 76 patients (aged > 18 years) scheduled for lobectomy or pneumonectomy were randomised 1:1 using a computer-generated list to receive an ultrasound-guided supraclavicular phrenic nerve block with 10 ml ropivacaine or 10 ml saline (placebo) immediately following surgery. A nerve catheter was subsequently inserted and treatment continued for 3 days. The study drug was pharmaceutically pre-packed in sequentially numbered identical vials assuring that all participants, healthcare providers and data collectors were blinded. The primary outcome was the incidence of unilateral shoulder pain within the first 6 h after surgery. Pain was evaluated using a numeric rating scale. Nine of 38 patients in the ropivacaine group and 26 of 38 patients in the placebo group experienced shoulder pain during the first 6 h after surgery (absolute risk reduction 44% (95% CI 22-67%), relative risk reduction 65% (95% CI 41-80%); p = 0.00009). No major complications, including respiratory compromise or nerve injury, were observed. We conclude that ultrasound-guided supraclavicular phrenic nerve block is an effective technique for reducing the incidence of ipsilateral shoulder pain after thoracic surgery.

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Section: Discussionsupporting

confidence: 92%

A randomised, controlled, double-blind trial of ultrasound-guided phrenic nerve block to prevent shoulder pain after thoracic surgery

et al. 2016

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“…Consistent with previous study findings, the utilization of preoperative education and non-pharmacological therapy play a vital role in decreasing pain intensity after thoracic surgery (Chou et al 2016;Schug et al 2015). A similar pattern of results was obtained for SROM and LOSAS as there was no difference in the improvement in SROM (Barrett et al 2017;Bunchungmongkol et al 2014;Ohmori et al 2013;Sowa et al 2017) and LOSAS (Giambrone et al 2016;Meyenfeldt et al 2018). These findings might be attributed to the consequence of pain after thoracic surgery, which can impede the SROM for more than 3 days after surgery (Barrett et al 2017;Blichfeldt-Eckhardt et al 2017;Bunchungmongkol et al 2014;Garusi et al 2016;Giambrone et al 2016;Meyenfeldt et al 2018;Sowa et al 2017).…”

Section: Discussion Of Findingssupporting

confidence: 87%

Nurse‐led post‐thoracic surgery pain management programme: its outcomes in a Nigerian Hospital

Odejobi

Maneewat

Chittithavorn

2019

International Nursing Review

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Aim The overarching aim of this study was to investigate the effects of a nurse‐led pain management programme on pain intensity, side effects of treatment, shoulder range of motion and length of stay after thoracic surgery. Background Post‐thoracic surgical pain is a major source of stress and distress for patients. It has profound effects ranging from increased risks in developing chronic post‐thoracic surgery pain to an increased length of stay after surgery. The post‐thoracic surgical pain management in the Nigerian context is based on the traditional approach that is dependent on the attending medical and nursing staff. Methods The study was a quasi‐experimental design (two‐group post‐test only). The study was conducted in a Nigerian hospital. Forty‐two patients were recruited and consecutively assigned into either the usual pain management group or the intervention group after they had met the inclusion criteria. Data were collected utilizing the following: (1) the modified McGill Pain Questionnaire; (2) a Numeric Rating Scale; (3) the documentation form for thoracic surgery pain management outcomes and (4) a goniometer. Results The findings indicated that pain intensity, nausea and drowsiness were significantly reduced among the patients in the experimental group than the control group, while the duration of stay after surgery and the shoulder range of motion were not different between the groups. Conclusion This study's results suggest that the intervention in question for patients undergoing thoracic surgery had a positive effect on reducing pain intensity, nausea and drowsiness but not the shoulder range of motion and length of stay after surgery. Implications for nursing policy Nursing policymakers may need to give a serious consideration to the revision of policies related to the nursing education curriculum as well as the in‐service training curriculum regarding pain management by nurses especially after surgery. Likewise, future research on other populations employing an improved methodology as well as utilizing up‐to‐date evidence by nurses across different hospitals may be necessary.

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“…There are many unproved or partially proved hypotheses regarding the etiology of ISP including transection of major bronchi, ligament distraction or strain as the result of surgical retraction, shoulder joint strain from intraoperative mal-positioning, myofascial involvement, irritation of the pleura by chest drains, and referred pain from irritation of the pericardium, mediastinum, or diaphragmatic surface [3, 5, 11, 17, 20, 21]. …”

Section: Etiologymentioning

confidence: 99%

“…Myofascial involvement has also been reported to contribute at least partially to postthoracotomy shoulder pain [21]. …”

Section: Etiologymentioning

confidence: 99%

Postthoracotomy Ipsilateral Shoulder Pain: A Literature Review on Characteristics and Treatment

Yousefshahi

Predescu

Colizza

et al. 2016

Pain Research and Management

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Context. Postthoracotomy Ipsilateral Shoulder Pain (IPS) is a common and sometimes intractable pain syndrome. IPS is different from chest wall pain in type, origin, and treatments. Various treatments are suggested or applied for it but none of them is regarded as popular accepted effective one. Objectives. To review data and collect all present experiences about postthoracotomy IPS and its management and suggest future research directions. Methods. Search in PubMed database and additional search for specific topics and review them to retrieve relevant articles as data source in a narrative review article. Results. Even in the presence of effective epidural analgesia, ISP is a common cause of severe postthoracotomy pain. The phrenic nerve has an important role in the physiopathology of postthoracotomy ISP. Different treatments have been applied or suggested. Controlling the afferent nociceptive signals conveyed by the phrenic nerve at various levels—from peripheral branches on the diaphragm to its entrance in the cervical spine—could be of therapeutic value. Despite potential concerns about safety, intrapleural or phrenic nerve blocks are tolerated well, at least in a selected group of patient. Conclusion. Further researches could be directed on selective sensory block and motor function preservation of the phrenic nerve. However, the safety and efficacy of temporary loss of phrenic nerve function and intrapleural local anesthetics should be assessed.

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Myofascial Involvement of Supra- and Infraspinatus Muscles Contributes to Ipsilateral Shoulder Pain After Muscle-Sparing Thoracotomy and Video-Assisted Thoracic Surgery

Cited by 21 publications

References 17 publications

A randomised, controlled, double-blind trial of ultrasound-guided phrenic nerve block to prevent shoulder pain after thoracic surgery

A randomised, controlled, double-blind trial of ultrasound-guided phrenic nerve block to prevent shoulder pain after thoracic surgery

Nurse‐led post‐thoracic surgery pain management programme: its outcomes in a Nigerian Hospital

Postthoracotomy Ipsilateral Shoulder Pain: A Literature Review on Characteristics and Treatment

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