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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

Published online by Cambridge University Press:  01 July 2007

G. Danelli ,
M. Berti ,
A. Casati ,
A. Bobbio ,
D. Ghisi ,
R. Mele ,
E. Rossini  and
G. Fanelli
G. Danelli
Affiliation:
University of Parma, Department of Anaesthesia and Pain Therapy, Ospedale Maggiore di Parma, Parma, Italy
M. Berti
Affiliation:
University of Parma, Department of Anaesthesia and Pain Therapy, Ospedale Maggiore di Parma, Parma, Italy
A. Casati*
Affiliation:
University of Parma, Department of Anaesthesia and Pain Therapy, Ospedale Maggiore di Parma, Parma, Italy
A. Bobbio
Affiliation:
University of Parma, Department of Thoracic Surgery, Ospedale Maggiore di Parma, Parma, Italy
D. Ghisi
Affiliation:
University of Parma, Department of Anaesthesia and Pain Therapy, Ospedale Maggiore di Parma, Parma, Italy
R. Mele
Affiliation:
University of Parma, Department of Anaesthesia and Pain Therapy, Ospedale Maggiore di Parma, Parma, Italy
E. Rossini
Affiliation:
University of Parma, Department of Anaesthesia and Pain Therapy, Ospedale Maggiore di Parma, Parma, Italy
G. Fanelli
Affiliation:
University of Parma, Department of Anaesthesia and Pain Therapy, Ospedale Maggiore di Parma, Parma, Italy
*
Correspondence to: Andrea Casati, Department of Anaesthesia and Pain Therapy, University of Parma, Ospedale Maggiore di Parma, Via Gramsci, 14 – 43100 Parma, Italy. E-mail: andrea.casati@unipr.it; Tel: +39 0521 702161; Fax: +39 0521 984735
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Summary

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.

Keywords

THORACIC SURGERYEPIDURAL ANAESTHESIA, thoracicPHRENIC NERVEROPIVACAINESHOULDER PAIN
Type
EACTA Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 7 , July 2007 , pp. 596 - 601
Copyright
Copyright © European Society of Anaesthesiology 2007

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