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Preoperatıve Ultrasound-Guıded Suprascapular Nerve Block for Postthoracotomy Shoulder Paın()

BACKGROUND: Acute postthoracotomy pain is a well-known potential problem, with pulmonary complications, ineffective respiratory rehabilitation, and delayed mobilization in the initial postoperative period, and it is followed by chronic pain. The type of thoracotomy, intercostal nerve damage, muscle...

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Autores principales: Özyuvaci, Emine, Akyol, Onat, Şitilci, Tolga, Dübüs¸, Türkan, Topac¸ogˇlu, Hakan, Leblebici, Hülya, Ac¸ikgöz, Alican
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3862194/
https://www.ncbi.nlm.nih.gov/pubmed/24385221
http://dx.doi.org/10.1016/j.curtheres.2012.12.004
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author Özyuvaci, Emine
Akyol, Onat
Şitilci, Tolga
Dübüs¸, Türkan
Topac¸ogˇlu, Hakan
Leblebici, Hülya
Ac¸ikgöz, Alican
author_facet Özyuvaci, Emine
Akyol, Onat
Şitilci, Tolga
Dübüs¸, Türkan
Topac¸ogˇlu, Hakan
Leblebici, Hülya
Ac¸ikgöz, Alican
author_sort Özyuvaci, Emine
collection PubMed
description BACKGROUND: Acute postthoracotomy pain is a well-known potential problem, with pulmonary complications, ineffective respiratory rehabilitation, and delayed mobilization in the initial postoperative period, and it is followed by chronic pain. The type of thoracotomy, intercostal nerve damage, muscle retraction, costal fractures, pleural irritation, and incision scar are the most responsible mechanisms. OBJECTIVE: Our aim was to assess whether preoperative ultrasound suprascapular nerve block with thoracic epidural analgesia was effective for postthoracotomy shoulder pain relief. METHODS: Thirty-six American Society of Anesthesiologist classification physical status I–III patients (2011–2012), with a diagnosis of lung cancer and scheduled for elective open-lung surgery, were prospectively included in the study. Eighteen of the patients received an ultrasound-guided suprascapular nerve block with 10-mL 0.5% levobupivacaine, using a 22-gauge spinal needle, 1 hour before operation (group S); 18 other patients had thoracic epidural analgesia only, and no nerve block was performed. Standard general anesthesia was administered. Degree of shoulder pain was assessed by a blinded observer when discharging patients from the recovery room, and thereafter at 1, 3, 6, 12, 24, 36, 48, and 72 hours on infusion at rest and 12, 24, 36, 48, and 72 hours on coughing. The same blinded observer also recorded the total amount of epidural levobupivacaine and fentanyl used by the 2 groups. RESULTS: In the suprascapular block group, the total amount of levobupivacaine (P = 0.0001) and fentanyl (P = 0.005) used postoperatively was statistically lower than in the epidural group. Visual analogue scale measurements in the suprascapular group were statistically significantly lower at 0, 1, 3, 6, 12, 24, 36, and 48 hours than those in the epidural group, both at rest and coughing. CONCLUSION: Postthoracotomy shoulder pain reduces patient function and postsurgical rehabilitation potential after thoracotomy, and various studies on explaining the etiology and management of postthoracotomy shoulder pain have been conducted. Theories of the etiology involved either musculoskeletal origin or referred pain. In this study, we concluded that preoperative ultrasound-guided suprascapular nerve block with thoracic epidural analgesia could achieve effective shoulder pain relief for 72 hours postoperatively, both at rest and coughing.
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spelling pubmed-38621942013-12-26 Preoperatıve Ultrasound-Guıded Suprascapular Nerve Block for Postthoracotomy Shoulder Paın() Özyuvaci, Emine Akyol, Onat Şitilci, Tolga Dübüs¸, Türkan Topac¸ogˇlu, Hakan Leblebici, Hülya Ac¸ikgöz, Alican Curr Ther Res Clin Exp Article BACKGROUND: Acute postthoracotomy pain is a well-known potential problem, with pulmonary complications, ineffective respiratory rehabilitation, and delayed mobilization in the initial postoperative period, and it is followed by chronic pain. The type of thoracotomy, intercostal nerve damage, muscle retraction, costal fractures, pleural irritation, and incision scar are the most responsible mechanisms. OBJECTIVE: Our aim was to assess whether preoperative ultrasound suprascapular nerve block with thoracic epidural analgesia was effective for postthoracotomy shoulder pain relief. METHODS: Thirty-six American Society of Anesthesiologist classification physical status I–III patients (2011–2012), with a diagnosis of lung cancer and scheduled for elective open-lung surgery, were prospectively included in the study. Eighteen of the patients received an ultrasound-guided suprascapular nerve block with 10-mL 0.5% levobupivacaine, using a 22-gauge spinal needle, 1 hour before operation (group S); 18 other patients had thoracic epidural analgesia only, and no nerve block was performed. Standard general anesthesia was administered. Degree of shoulder pain was assessed by a blinded observer when discharging patients from the recovery room, and thereafter at 1, 3, 6, 12, 24, 36, 48, and 72 hours on infusion at rest and 12, 24, 36, 48, and 72 hours on coughing. The same blinded observer also recorded the total amount of epidural levobupivacaine and fentanyl used by the 2 groups. RESULTS: In the suprascapular block group, the total amount of levobupivacaine (P = 0.0001) and fentanyl (P = 0.005) used postoperatively was statistically lower than in the epidural group. Visual analogue scale measurements in the suprascapular group were statistically significantly lower at 0, 1, 3, 6, 12, 24, 36, and 48 hours than those in the epidural group, both at rest and coughing. CONCLUSION: Postthoracotomy shoulder pain reduces patient function and postsurgical rehabilitation potential after thoracotomy, and various studies on explaining the etiology and management of postthoracotomy shoulder pain have been conducted. Theories of the etiology involved either musculoskeletal origin or referred pain. In this study, we concluded that preoperative ultrasound-guided suprascapular nerve block with thoracic epidural analgesia could achieve effective shoulder pain relief for 72 hours postoperatively, both at rest and coughing. Elsevier 2013-06 /pmc/articles/PMC3862194/ /pubmed/24385221 http://dx.doi.org/10.1016/j.curtheres.2012.12.004 Text en © 2013 The Authors http://creativecommons.org/licenses/by/3.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
spellingShingle Article
Özyuvaci, Emine
Akyol, Onat
Şitilci, Tolga
Dübüs¸, Türkan
Topac¸ogˇlu, Hakan
Leblebici, Hülya
Ac¸ikgöz, Alican
Preoperatıve Ultrasound-Guıded Suprascapular Nerve Block for Postthoracotomy Shoulder Paın()
title Preoperatıve Ultrasound-Guıded Suprascapular Nerve Block for Postthoracotomy Shoulder Paın()
title_full Preoperatıve Ultrasound-Guıded Suprascapular Nerve Block for Postthoracotomy Shoulder Paın()
title_fullStr Preoperatıve Ultrasound-Guıded Suprascapular Nerve Block for Postthoracotomy Shoulder Paın()
title_full_unstemmed Preoperatıve Ultrasound-Guıded Suprascapular Nerve Block for Postthoracotomy Shoulder Paın()
title_short Preoperatıve Ultrasound-Guıded Suprascapular Nerve Block for Postthoracotomy Shoulder Paın()
title_sort preoperatıve ultrasound-guıded suprascapular nerve block for postthoracotomy shoulder paın()
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3862194/
https://www.ncbi.nlm.nih.gov/pubmed/24385221
http://dx.doi.org/10.1016/j.curtheres.2012.12.004
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