Pain Research and Management / 2016 / Article / Tab 1

Review Article

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

Table 1

Advantages and disadvantages of different techniques of management of ISP.

TechniqueEfficacy in Ipsilateral Shoulder Pain (ISP)AdvantagesDisadvantagesComments

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)Yes [3, 68]
Partial effect [5]
Simplicity of use
Cross-effectivity for other pain syndromes
Unwanted side effects and contraindications
Limited level of efficacy
Considered as coanalgesia

AcetaminophenYes [15]Simplicity of use
Cross-effectivity for other pain syndromes
May be effective as preemptive analgesia
Well tolerated
Limited level of efficacyConsidered as coanalgesia

GabapentinYes [27, 29, 30]
No [19, 31]
Simplicity of use
Cross-effectivity for other pain syndromes
More effective in ISP in abdominal surgeries
May cause dizziness or sedation
Considered as coanalgesia

Systemic ketamine There is no report(s) about ISP
Several reports about efficacy thoracotomy pain management [3237] or against it [32, 35, 36]
Simplicity of use
Cross-effectivity for other pain syndromes
May be effective in prevention of chronic post thoracotomy pain development
May cause dizziness, sedation, or other neurologic or cardiac side effectsMore researches are required

Thoracic epiduralOptimal analgesia for incisional pain [3841]
At levels higher than T5 effective on ISP [22]
Not effective for ISP [5, 6, 8, 15, 16]
Excellent pain relief for incisional pain
Limited or no efficacy on ISP
Hemodynamic effects
Invasive method
Needing further assessments
Recommended for all thoracotomy patients
More research about the efficacy of epidurals higher than T5 in management of ISP

Intraoperative local anesthetic infiltration of the phrenic nerve at the level of the diaphragm Yes [5, 7, 9, 10]Significant effect on prevention of ISP
Simple and effective
There are reports about its safety
Short duration of effect
Impossibility to repeat
Concerns about hemidiaphragmatic weakness
Needing surgical access
Recommended as a preventive effective method in otherwise healthy patients
Need more assessments of safety at least in special subgroups of patient
Needs development of technique and medication selection

Stellate ganglion block Yes [7, 16]Possible to repeatInvasive
Unwanted effects and side effects of stellate ganglion block
To be considered as a possibility to treatment of ISP in special patient
Needing development of technique and medication selection

Interscalene brachial plexus blockYes [7, 17, 18, 24]Possible to repeatInvasive
Unwanted effects and side effects of brachial plexus block
To be considered as a possibility to treatment of ISP in special patient including multiple trauma of shoulder or arm
Needing development of technique and medication selection

Direct blockade of the phrenic nerveYes (inadvertent) [17]Possible to repeatInvasive
Concerning about hemidiaphragmatic weakness
Needing more assessments of safety and efficacy
Needing development of technique and medication selection

Intrapleural blockYes [4250]
No [11, 5155]
Safe and easy
Could be repeated as needed
Could be perform via chest tubes
Some systemic side effects of intrapleural medications
No effect on incisional pain or epidural analgesia requirement
Sometimes incomplete block
Could be considered as the first option in early postoperative phase, when clots, secretions, and adhesion bonds are minimal and ISP have the highest severity
Needing more studies for development of technique and medication selection

Suprascapular nerve block
Yes [10, 12, 17, 56]
No [13]
Possible to repeatInvasive
Unwanted effects and side effects of
Less effectiveness in compare with phrenic nerve block
Needing more assessments of safety and efficacy
To be considered as a possibility to treatment of ISP in special patient including multiple trauma of shoulder or arm

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