Post Thoracotomy Shoulder Pain and its Attenuation with 0.2 % Ropivacaine via Intrapleural Instillation or Phrenic Nerve Infiltration.

Abstract

Post Thoracotomy Shoulder Pain and its Attenuation with 0.2% Ropivacaine via Intrapleural Instillation or Phrenic Nerve Infiltration.
BACKGROUND: Post thoracotomy ipsilateral shoulder pain is the most common complication. It can be very severe and poses the most challenging aspect for treatment. The adverse effects of thoracotomy on pulmonary functions can be decreased by providing effective perioperative analgesia
OBJECTIVE(S): To study
 The effectiveness of intrapleural ropivacaine in comparison with phrenic nerve infiltration with ropivacaine on shoulder pain post thoracotomy.
 The effect of ropivacaine on hemodynamics.
 The effect of ropivacaine on Oxygen Saturation by Pulse oximeter.
 Any adverse effect of ropivacaine in perioperative period.
STUDY DESIGN: Prospective observational study.
PARTICIPANTS: 80 patients of ASA 1,2 and 3, undergoing elective unilateral thoracotomy, divided equally into 2 groups were included in this study.
METHODS: Group A (Intrapleural instillation) received 40ml of 0.2% Ropivacaine with 1:100000 epinephrine into basal chest drain at the end of the surgery and Group B (Phrenic nerve infiltration) received 10ml of 0.2% Ropivacaine into phrenic nerve prior to chest closure. Postoperatively patients were assessed for PTISP using VAS score at 0, 1,3, 6, 12, 24,36 and 48 hours(hr). The number of rescue analgesia required were recorded.
RESULTS: PTISP was relieved significantly in Group B as compared to Group A. The number of rescue analgesic required was less in Group B than in Group A (P value<0.05). Postoperative Hemodynamics were stable in Group B than in Group A.
CONCLUSION: Phrenic Nerve Infiltration significantly reduced the incidence and delayed the onset of PTISP as compared to Intrapleural Instillation and was not associated with any adverse effects.
IMPLICATIONS: Best possible approach for PTISP with improved respiratory functions