Nda. Scawn et al., Ipsilateral shoulder pain after thoracotomy with epidural analgesia: The influence of phrenic nerve infiltration with lidocaine, ANESTH ANAL, 93(2), 2001, pp. 260-264
Citations number
12
Categorie Soggetti
Aneshtesia & Intensive Care","Medical Research Diagnosis & Treatment
Patients receiving effective thoracic epidural analgesia for postthoracotom
y pain may still complain of severe ipsilateral shoulder pain. The etiology
of this pain is unclear. In this randomized, double-blinded, placebo-contr
olled study, we investigated the effect of phrenic nerve infiltration with
lidocaine or saline on postoperative shoulder pain in 48 patients. After co
mpletion of a lung resection, patients received either 10 mL of 1% lidocain
e or 10 mL of 0.9% saline infiltrated into the periphrenic fat pad at the l
evel of the diaphragm. Shoulder pain was experienced by 33% of patients rec
eiving lidocaine, compared with 85% of patients receiving saline (P < 0.008
). Overall pain scores were lower with lidocaine (P < 0.05). Paco(2) values
were not significantly higher with lidocaine in the first 2 h. We conclude
that pain transmitted via the phrenic nerve and referred to the shoulder i
s the most likely explanation for the ipsilateral shoulder pain experienced
by patients receiving epidural analgesia for postthoracotomy pain.