title: Preoperatıve ultrasound-guıded suprascapular nerve block for postthoracotomy shoulder paın.
abstract: BACKGROUND
  Acute postthoracotomy pain is a well-known potential problem, with pulmonary complications, ineffective respiratory rehabilitation, and delayed mobilization in the initial postoperative period, and it is followed by chronic pain. The type of thoracotomy, intercostal nerve damage, muscle retraction, costal fractures, pleural irritation, and incision scar are the most responsible mechanisms.
  
  
  OBJECTIVE
  Our aim was to assess whether preoperative ultrasound suprascapular nerve block with thoracic epidural analgesia was effective for postthoracotomy shoulder pain relief.
  
  
  METHODS
  Thirty-six American Society of Anesthesiologist classification physical status I-III patients (2011-2012), with a diagnosis of lung cancer and scheduled for elective open-lung surgery, were prospectively included in the study. Eighteen of the patients received an ultrasound-guided suprascapular nerve block with 10-mL 0.5% levobupivacaine, using a 22-gauge spinal needle, 1 hour before operation (group S); 18 other patients had thoracic epidural analgesia only, and no nerve block was performed. Standard general anesthesia was administered. Degree of shoulder pain was assessed by a blinded observer when discharging patients from the recovery room, and thereafter at 1, 3, 6, 12, 24, 36, 48, and 72 hours on infusion at rest and 12, 24, 36, 48, and 72 hours on coughing. The same blinded observer also recorded the total amount of epidural levobupivacaine and fentanyl used by the 2 groups.
  
  
  RESULTS
  In the suprascapular block group, the total amount of levobupivacaine (P = 0.0001) and fentanyl (P = 0.005) used postoperatively was statistically lower than in the epidural group. Visual analogue scale measurements in the suprascapular group were statistically significantly lower at 0, 1, 3, 6, 12, 24, 36, and 48 hours than those in the epidural group, both at rest and coughing.
  
  
  CONCLUSIONS
  Postthoracotomy shoulder pain reduces patient function and postsurgical rehabilitation potential after thoracotomy, and various studies on explaining the etiology and management of postthoracotomy shoulder pain have been conducted. Theories of the etiology involved either musculoskeletal origin or referred pain. In this study, we concluded that preoperative ultrasound-guided suprascapular nerve block with thoracic epidural analgesia could achieve effective shoulder pain relief for 72 hours postoperatively, both at rest and coughing.
authors.affiliation: Department of Anesthesiology and Pain Medicine, İstanbul Training and Research Hospital, İstanbul, Turkey.
authors.forename: Emine
authors.initials: E
authors.lastname: Ozyuvaci
authors.affiliation: Department of Anesthesiology and Pain Medicine, İstanbul Training and Research Hospital, İstanbul, Turkey.
authors.forename: Onat
authors.initials: O
authors.lastname: Akyol
authors.affiliation: Department of Anesthesiology and Pain Medicine, İstanbul Training and Research Hospital, İstanbul, Turkey.
authors.forename: Tolga
authors.initials: T
authors.lastname: Sitilci
authors.affiliation: Department of Thoracic Surgery, İstanbul Training and Research Hospital, İstanbul, Turkey.
authors.forename: Türkan
authors.initials: T
authors.lastname: Dübüs
authors.affiliation: Department of Emergency Medicine, İstanbul Training and Research Hospital, İstanbul, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Topac Ogˇlu
authors.affiliation: Department of Anesthesiology and Pain Medicine, İstanbul Training and Research Hospital, İstanbul, Turkey.
authors.forename: Hülya
authors.initials: H
authors.lastname: Leblebici
authors.affiliation: Department of Anesthesiology and Pain Medicine, İstanbul Training and Research Hospital, İstanbul, Turkey.
authors.forename: Alican
authors.initials: A
authors.lastname: Ac Ikgöz
keywords: postthoracotomy; shoulder pain; suprascapular nerve; ultrasound