Post-thoracotomy ipsilateral shoulder pain: What should be preferred to optimize it - phrenic nerve infiltration or paracetamol infusion?
Acetaminophen
/ administration & dosage
Adult
Analgesics, Non-Narcotic
/ administration & dosage
Anesthetics, Local
/ administration & dosage
Double-Blind Method
Female
Humans
Male
Middle Aged
Pain Measurement
Pain, Postoperative
/ drug therapy
Phrenic Nerve
Prospective Studies
Ropivacaine
/ administration & dosage
Shoulder Pain
/ drug therapy
Thoracotomy
/ adverse effects
Young Adult
Paracetamol
phrenic nerve infiltration
post thoracotomy pain
post-thoracotomy ipsilateral shoulder pain
ropivacaine
thoracic epidural analgesia
Journal
Annals of cardiac anaesthesia
ISSN: 0974-5181
Titre abrégé: Ann Card Anaesth
Pays: India
ID NLM: 9815987
Informations de publication
Date de publication:
Historique:
entrez:
6
7
2019
pubmed:
6
7
2019
medline:
7
7
2020
Statut:
ppublish
Résumé
Post thoracotomy ipsilateral shoulder pain (PTISP) is a distressing and highly prevalent problem after thoracic surgery and has not received much attention despite the incidence as high as 85%. To study the effect of phrenic nerve infiltration with Ropivacaine compared to paracetamol infusion on PTISP in thoracotomy patients with epidural analgesia as standard mode of incisional analgesia in both the groups. Prospective Randomised and Double Blind Study. 126 adult patients were divided randomly into 2 groups, "Group A (Phrenic Nerve Infiltration Group) received 10 mL of 0.2% Ropivacaine close to the diaphragm into the periphrenic fat pad" and "Group B (Paracetamol Infusion Group) received 20mg/kg paracetamol infusion" 30 minutes prior to chest closure respectively. A blinded observer assessed the patients PTISP using the VAS score at 1, 4, 8, 12 and 24 hours (h) postoperatively. The time and number of any rescue analgesic medication were recorded. PTISP was relieved significantly in Group A (25.4℅) as compared to Group B (61.9℅), with significantly higher mean duration of analgesia in Group A. The mean time for first rescue analgesia was significantly higher in Group A (11.1 ± 7.47 hours) than in Group B (7.40 ± 5.30 hours). The number of rescue analgesic required was less in Group A 1.6 ± 1.16 as compared to Group B 2.9 ± 1.37 (P value <0.5). Phrenic Nerve Infiltration significantly reduced the incidence and delayed the onset of PTISP as compared to paracetamol infusion and was not associated with any adverse effects.
Sections du résumé
Background
Post thoracotomy ipsilateral shoulder pain (PTISP) is a distressing and highly prevalent problem after thoracic surgery and has not received much attention despite the incidence as high as 85%.
Objectives
To study the effect of phrenic nerve infiltration with Ropivacaine compared to paracetamol infusion on PTISP in thoracotomy patients with epidural analgesia as standard mode of incisional analgesia in both the groups.
Study Design
Prospective Randomised and Double Blind Study.
Methods
126 adult patients were divided randomly into 2 groups, "Group A (Phrenic Nerve Infiltration Group) received 10 mL of 0.2% Ropivacaine close to the diaphragm into the periphrenic fat pad" and "Group B (Paracetamol Infusion Group) received 20mg/kg paracetamol infusion" 30 minutes prior to chest closure respectively. A blinded observer assessed the patients PTISP using the VAS score at 1, 4, 8, 12 and 24 hours (h) postoperatively. The time and number of any rescue analgesic medication were recorded.
Results
PTISP was relieved significantly in Group A (25.4℅) as compared to Group B (61.9℅), with significantly higher mean duration of analgesia in Group A. The mean time for first rescue analgesia was significantly higher in Group A (11.1 ± 7.47 hours) than in Group B (7.40 ± 5.30 hours). The number of rescue analgesic required was less in Group A 1.6 ± 1.16 as compared to Group B 2.9 ± 1.37 (P value <0.5).
Conclusions
Phrenic Nerve Infiltration significantly reduced the incidence and delayed the onset of PTISP as compared to paracetamol infusion and was not associated with any adverse effects.
Identifiants
pubmed: 31274492
pii: AnnCardAnaesth_2019_22_3_291_262107
doi: 10.4103/aca.ACA_76_18
pmc: PMC6639895
doi:
Substances chimiques
Analgesics, Non-Narcotic
0
Anesthetics, Local
0
Acetaminophen
362O9ITL9D
Ropivacaine
7IO5LYA57N
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
291-296Références
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