title: Suprascapular nerve block for ipsilateral shoulder pain after thoracotomy with thoracic epidural analgesia: a double-blind comparison of 0.5% bupivacaine and 0.9% saline.
abstract: Despite receiving thoracic epidural analgesia, severe ipsilateral shoulder pain is common in patients after thoracotomy. We recruited 44 patients into a double-blinded randomized placebo-controlled study to investigate whether suprascapular nerve block would treat postthoracotomy shoulder pain effectively. All patients received a standard anesthetic with a midthoracic epidural. Thirty patients who experienced shoulder pain within 2 h of surgery were randomly assigned to receive a suprascapular nerve block with either 10 mL of 0.5% bupivacaine or 10 mL of 0.9% saline. Shoulder pain was assessed before nerve blockade, at 30 min, and then hourly for 6 h after the block using a visual analog scale (VAS) and a 5-point verbal ranking score (VRS). The incidence of shoulder pain before nerve block was 78%. There was no significant decrease in either VAS or VRS in the Bupivacaine group. These results suggest that this pain is unlikely to originate in the shoulder and lead us to question the role of a somatic afferent in referred visceral pain. We conclude that suprascapular nerve block does not treat ipsilateral shoulder pain after thoracotomy in patients with an effective thoracic epidural.
  
  
  CONCLUSIONS
  This randomized, double-blinded, placebo-controlled trial showed that suprascapular nerve block does not treat the severe ipsilateral shoulder pain that patients experience after thoracotomy. This has implications for established theories of referred pain and indicates that this pain is unlikely to originate in the shoulder.
authors.affiliation: Department of Anaesthesia and The National Refractory Angina Centre, The Cardiothoracic Centre Liverpool NHS Trust, Liverpool, England.
authors.forename: Ngukhoon
authors.initials: N
authors.lastname: Tan
authors.forename: Neil M
authors.initials: NM
authors.lastname: Agnew
authors.forename: Nigel D
authors.initials: ND
authors.lastname: Scawn
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Pennefather
authors.forename: Michael
authors.initials: M
authors.lastname: Chester
authors.forename: Glenn N
authors.initials: GN
authors.lastname: Russell
mesh_terms: D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D010147:Pain Measurement; D010149:Postoperative Pain / Q000628:therapy*; D020069:Shoulder Pain / Q000209:etiology / Q000628:therapy*; D012965:Sodium Chloride; D013908:Thoracotomy / Q000009:adverse effects
chemical_list: D000779:Anesthetics, Local; D012965:Sodium Chloride; D002045:Bupivacaine