title: A randomised, controlled, double-blind trial of ultrasound-guided phrenic nerve block to prevent shoulder pain after thoracic surgery.
abstract: Moderate to severe ipsilateral shoulder pain is a common complaint following thoracic surgery. In this prospective, parallel-group study at Odense University Hospital, 76 patients (aged > 18 years) scheduled for lobectomy or pneumonectomy were randomised 1:1 using a computer-generated list to receive an ultrasound-guided supraclavicular phrenic nerve block with 10 ml ropivacaine or 10 ml saline (placebo) immediately following surgery. A nerve catheter was subsequently inserted and treatment continued for 3 days. The study drug was pharmaceutically pre-packed in sequentially numbered identical vials assuring that all participants, healthcare providers and data collectors were blinded. The primary outcome was the incidence of unilateral shoulder pain within the first 6 h after surgery. Pain was evaluated using a numeric rating scale. Nine of 38 patients in the ropivacaine group and 26 of 38 patients in the placebo group experienced shoulder pain during the first 6 h after surgery (absolute risk reduction 44% (95% CI 22-67%), relative risk reduction 65% (95% CI 41-80%); p = 0.00009). No major complications, including respiratory compromise or nerve injury, were observed. We conclude that ultrasound-guided supraclavicular phrenic nerve block is an effective technique for reducing the incidence of ipsilateral shoulder pain after thoracic surgery.
authors.affiliation: Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark.
authors.forename: M R
authors.initials: MR
authors.lastname: Blichfeldt-Eckhardt
authors.affiliation: Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.
authors.forename: C B
authors.initials: CB
authors.lastname: Laursen
authors.affiliation: Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Berg
authors.affiliation: Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark.
authors.forename: J H
authors.initials: JH
authors.lastname: Holm
authors.affiliation: Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark.
authors.forename: L N
authors.initials: LN
authors.lastname: Hansen
authors.affiliation: Department of Anaesthesiology, Vejle Hospital, Vejle, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Ørding
authors.affiliation: Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark.
authors.forename: C
authors.initials: C
authors.lastname: Andersen
authors.affiliation: Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark.
authors.forename: P B
authors.initials: PB
authors.lastname: Licht
authors.affiliation: Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark.
authors.forename: P
authors.initials: P
authors.lastname: Toft
mesh_terms: D000368:Aged; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control*; D010791:Phrenic Nerve; D011446:Prospective Studies; D020069:Shoulder Pain / Q000517:prevention & control*; D019616:Thoracic Surgical Procedures / Q000009:adverse effects*; D018084:Ultrasonography, Interventional
keywords: anaesthetic techniques; nerve block; pain management; phrenic nerve; ultrasound structures