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Postthoracotomy shoulder pain: diagnosis and management
1Department of Anesthesia, QEII Health Sciences Centre, Halifax, Nova Scotia, B3H 2Y9, Canada. pcmacdou@dal.ca
Current Opinion in Anaesthesiology
|January 16, 2008
Summary
Post-thoracotomy shoulder pain is common after chest surgery. Evidence suggests the phrenic nerve may cause this pain, and effective prevention and treatment are possible.
Area of Science:
- Thoracic surgery outcomes
- Pain management
- Neuropathic pain
Background:
- Post-thoracotomy/scopy ipsilateral shoulder pain (ISP) is a frequent and severe complication following chest surgery.
- Current understanding of ISP etiology is limited, with diagnostic challenges in existing literature.
Purpose of the Study:
- To review the diagnostic challenges and proposed etiology of post-thoracotomy/scopy ipsilateral shoulder pain.
- To discuss perioperative management strategies for prevention and treatment of ISP.
- To propose a multimodal management approach and identify areas for future research.
Main Methods:
- Literature review of studies on post-thoracotomy/scopy ipsilateral shoulder pain.
- Analysis of recent randomized controlled trials and prospective natural history studies.
- Synthesis of evidence regarding pain etiology and management.
Main Results:
- Few studies exist on post-thoracotomy/scopy ISP, and its cause remains unclear.
- Recent research implicates the phrenic nerve in the development of this pain syndrome.
- Other contributing pain sources have been identified in prospective studies.
Conclusions:
- Post-thoracotomy/scopy ISP appears to be intense but temporary.
- The impact of ISP on overall perioperative morbidity requires further investigation.
- Future research should focus on identifying risk factors for ISP.
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