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Pain Research and Management
Volume 2016, Article ID 3652726, 9 pages
Review Article

Postthoracotomy Ipsilateral Shoulder Pain: A Literature Review on Characteristics and Treatment

1Department of Anesthesia, Tehran University of Medical Sciences, Tehran, Iran
2Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada
3Department of Anesthesia, Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada
4Department of Anesthesia, McGill University Health Centre, Montreal, QC, Canada

Received 11 August 2016; Accepted 25 September 2016

Academic Editor: Rudin Domi

Copyright © 2016 Fardin Yousefshahi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Context. Postthoracotomy Ipsilateral Shoulder Pain (IPS) is a common and sometimes intractable pain syndrome. IPS is different from chest wall pain in type, origin, and treatments. Various treatments are suggested or applied for it but none of them is regarded as popular accepted effective one. Objectives. To review data and collect all present experiences about postthoracotomy IPS and its management and suggest future research directions. Methods. Search in PubMed database and additional search for specific topics and review them to retrieve relevant articles as data source in a narrative review article. Results. Even in the presence of effective epidural analgesia, ISP is a common cause of severe postthoracotomy pain. The phrenic nerve has an important role in the physiopathology of postthoracotomy ISP. Different treatments have been applied or suggested. Controlling the afferent nociceptive signals conveyed by the phrenic nerve at various levels—from peripheral branches on the diaphragm to its entrance in the cervical spine—could be of therapeutic value. Despite potential concerns about safety, intrapleural or phrenic nerve blocks are tolerated well, at least in a selected group of patient. Conclusion. Further researches could be directed on selective sensory block and motor function preservation of the phrenic nerve. However, the safety and efficacy of temporary loss of phrenic nerve function and intrapleural local anesthetics should be assessed.