Low-volume interscalene brachial plexus block for post-thoracotomy shoulder pain.
OBJECTIVE
This study was designed to evaluate the effectiveness of low-volume interscalene brachial plexus block for post-thoracotomy ipsilateral shoulder pain and to compare it with nonsteroidal anti-inflammatory drug treatment.


METHODS
Prospective nonblinded study.


METHODS
University hospital.


METHODS
Sixty adult patients.


METHODS
Patients who underwent elective thoracic surgery under combined epidural and general anesthesia, and after surgery were free of incisional pain but complaining of shoulder pain, were included in the study. They were selected in a sequential manner and placed into 2 groups of 30 patients each. Group 1 had a low-volume interscalene brachial plexus block, using 10 mL of bupivacaine 0.5%. Group 2 had an intramuscular injection of diclofenac sodium, 75 mg.


RESULTS
Pain was measured during their stay in the postanesthesia care unit (PACU) by using a visual analog score (VAS). Opioids were administered when pain relief was incomplete. Pain intensity was re-estimated the next morning and patient satisfaction was scored. VAS was found to be significantly lower in the low-volume interscalene block group than in the diclofenac group at 30 minutes after treatment and when leaving PACU (p < 0.001 for both). Patients in the interscalene block group stayed longer in the PACU (p = 0.019), and significantly fewer required rescue opioids (p = 0.03). There was no significant difference between the groups in patient satisfaction with the pain treatment.


CONCLUSIONS
The authors concluded that low-volume interscalene brachial plexus block is a superior treatment for post-thoracotomy shoulder pain compared with diclofenac injection, although it requires a slightly longer stay in the PACU.
Department of Anesthesiology, Rambam Medical Center, Haifa, Israel.
Michal
M
Barak
Dmitri
D
Iaroshevski
Eleonardo
E
Poppa
Alon
A
Ben-Nun
Yeshayahu
Y
Katz
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000008:administration & dosage; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D001917:Brachial Plexus; D002045:Bupivacaine / Q000008:administration & dosage*; D004008:Diclofenac / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000628:therapy*; D011446:Prospective Studies; D020069:Shoulder Pain / Q000188:drug therapy*; D013908:Thoracotomy / Q000009:adverse effects*; D016896:Treatment Outcome
D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac; D002045:Bupivacaine