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

Abstract

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.

Ipsilateral Shoulder Pain After Thoracotomy: Multifactorial in Cause, New Treatment Option

“…Shoulder pain has been described in a separate section of a book chapter on pain management after thoracic surgery 9 and in a review article. 10 A few patient and surgical risk factors increase the likelihood of ipsilateral shoulder pain after thoracic surgery, such as the surgical approach being thoracotomy instead of videoassisted thoracic surgery, duration of surgery greater than 2 hours, and a thoracic epidural being placed lower than the T5 level. Shoulder pain could be referred pain through the phrenic nerve due to diaphragmatic irritation or somatic pain due to excess mobilization of the scapula.…”

The Efficacy of Systemic Lidocaine in the Management of Chronic Pain: A Literature Review

“…Lidocaine is an amide local anesthetic that in pain medicine, is widely used for local or regional infiltration in different settings to manage or prevent acute or chronic pain ( 9 , 10 ). Lidocaine hydrochloride has an elimination half-life of 1.5 to 2 hours after an intravenous bolus dose.…”

Comparison of Efficacy Outcomes of Lidocaine Spray, Topical Lidocaine Injection, and Lidocaine General Anesthesia in Nasal Bone Fractures Surgeries: A Randomized, Controlled Trial

“…Lidocaine is widely used as a general and local anesthetic following minor or major surgeries [ 6 ]. It has an analgesic effect, which is more than locally administered analgesic drugs [ 7 ].…”