Ipsilateral shoulder pain after thoracotomy surgery: a prospective, randomized, double-blind, placebo-controlled evaluation of the efficacy of infiltrating the phrenic nerve with 0.2%wt/vol ropivacaine.
BACKGROUND
The aim of this prospective, randomized, double-blind, placebo-controlled study was to evaluate the efficacy of phrenic nerve infiltration with ropivacaine 0.2% on the incidence and severity of ipsilateral shoulder pain after thoracotomy in patients receiving continuous thoracic epidural analgesia.


METHODS
Fifty ASA physical status II-III patients, receiving thoracic epidural analgesia for post-thoracotomy pain, were randomly allocated to receive infiltration of the ipsilateral phrenic nerve with either ropivacaine 0.2% 10 mL (ropivacaine, n = 25), or saline 0.9% (control, n = 25) just before lung expansion and chest closure. A blinded observer recorded the incidence and severity of ipsilateral shoulder pain 6, 12, 24, 36 and 48 h after surgery. Postoperative respiratory function was also evaluated with blood gas analyses.


RESULTS
The cumulative incidences of ipsilateral shoulder pain during the first 24 h after surgery were 8/25 in the ropivacaine and 16/25 in the control groups (P = 0.047), with median (range) onset times for shoulder pain of 2 (2-24) h with ropivacaine and 0.5 (0.5-24) h in controls (P = 0.005). No differences were reported on the second postoperative day. The areas under the curves of the amount of pain over time were 0 (0-2760) mm h for the ropivacaine and 350 (0-1900) mm h for the control groups (P = 0.06). Postoperatively, similar reductions in indices of oxygenation were observed in both groups.


CONCLUSIONS
Phrenic nerve infiltration with ropivacaine 0.2% 10 mL reduced the incidence and delayed the onset of ipsilateral shoulder pain during the first 24 h after open lung resection, with no clinically relevant effects on respiratory function.
Danelli
G
G
University of Parma, Department of Anaesthesia and Pain Therapy, Ospedale Maggiore di Parma, Parma, Italy.
Berti
M
M
Casati
A
A
Bobbio
A
A
Ghisi
D
D
Mele
R
R
Rossini
E
E
Fanelli
G
G
D000328:Adult; D000368:Aged; D000577:Amides / Q000008:administration & dosage*; D015360:Analgesia, Epidural; D000779:Anesthetics, Local / Q000008:administration & dosage*; D019540:Area Under Curve; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D015994:Incidence; D007267:Injections; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology / Q000517:prevention & control*; D010791:Phrenic Nerve / Q000187:drug effects*; D011013:Pneumonectomy; D011446:Prospective Studies; D000077212:Ropivacaine; D012720:Severity of Illness Index; D020069:Shoulder Pain / Q000453:epidemiology / Q000517:prevention & control*; D013908:Thoracotomy; D013997:Time Factors; D016896:Treatment Outcome
D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine