Phrenic nerve block on severe post-hepatectomy shoulder pain: A randomized, double-blind, placebo-controlled, pilot study
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Phrenic nerve block on severe post-hepatectomy shoulder pain : A randomized, double-blind, placebo-controlled, pilot study. / Bak, Theis S.; Bøgevig, Søren; Christensen, Amalie P.; Tollund, Carsten; Hillingso, Jens; Aasvang, Eske K.
I: Acta Anaesthesiologica Scandinavica, Bind 65, Nr. 9, 2021, s. 320-1328.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Phrenic nerve block on severe post-hepatectomy shoulder pain
T2 - A randomized, double-blind, placebo-controlled, pilot study
AU - Bak, Theis S.
AU - Bøgevig, Søren
AU - Christensen, Amalie P.
AU - Tollund, Carsten
AU - Hillingso, Jens
AU - Aasvang, Eske K.
PY - 2021
Y1 - 2021
N2 - BackgroundSevere shoulder pain occurs frequently after surgery close to the diaphragm, potentially caused by referred pain via the ipsilateral phrenic nerve. We aimed to assess the analgesic effect of an ultrasound-guided phrenic nerve block on moderate to severe right-sided shoulder pain after open partial hepatectomy.MethodsThis was a randomized, double-blind, placebo-controlled, pilot study, comparing ultrasound-guided phrenic nerve block (ropivacaine 0.75 mg/mL) versus placebo (isotonic sodium chloride 0.9 mg/mL) on severe post-hepatectomy shoulder pain (NRS ≥6). Pre- and postoperative spirometry and arterial blood gas analyses were used to assess respiratory function. Subjects with chronic lung disease were excluded. Unfortunately, due to lack of funding, the trial was ended prematurely and therefore presented as a pilot study.ResultsOne hundred and one subjects were screened for eligibility; 14 subjects were randomized, and two subjects were later excluded; thus, 12 subjects were analyzed with six in each group. A statistically significant difference in reduction in median pain intensity between groups was observed 15 minutes after phrenic nerve block (“ropivacaine first” ΔNRS: −6.0 [−6.0 to −3.0] vs. “saline first” ΔNRS: 0 [−6.0 to 1.0], P = .026). Spirometry results and arterial blood gas analyses were not clinically impacted by the block.ConclusionsPostoperative phrenic nerve block significantly reduced severe post-hepatectomy shoulder pain. Larger studies are warranted to confirm the lack of clinically relevant block-related impairment of respiratory function.
AB - BackgroundSevere shoulder pain occurs frequently after surgery close to the diaphragm, potentially caused by referred pain via the ipsilateral phrenic nerve. We aimed to assess the analgesic effect of an ultrasound-guided phrenic nerve block on moderate to severe right-sided shoulder pain after open partial hepatectomy.MethodsThis was a randomized, double-blind, placebo-controlled, pilot study, comparing ultrasound-guided phrenic nerve block (ropivacaine 0.75 mg/mL) versus placebo (isotonic sodium chloride 0.9 mg/mL) on severe post-hepatectomy shoulder pain (NRS ≥6). Pre- and postoperative spirometry and arterial blood gas analyses were used to assess respiratory function. Subjects with chronic lung disease were excluded. Unfortunately, due to lack of funding, the trial was ended prematurely and therefore presented as a pilot study.ResultsOne hundred and one subjects were screened for eligibility; 14 subjects were randomized, and two subjects were later excluded; thus, 12 subjects were analyzed with six in each group. A statistically significant difference in reduction in median pain intensity between groups was observed 15 minutes after phrenic nerve block (“ropivacaine first” ΔNRS: −6.0 [−6.0 to −3.0] vs. “saline first” ΔNRS: 0 [−6.0 to 1.0], P = .026). Spirometry results and arterial blood gas analyses were not clinically impacted by the block.ConclusionsPostoperative phrenic nerve block significantly reduced severe post-hepatectomy shoulder pain. Larger studies are warranted to confirm the lack of clinically relevant block-related impairment of respiratory function.
KW - nerve block
KW - pain management
KW - pain
KW - postoperative
KW - referred
KW - phrenic nerve
U2 - 10.1111/aas.13928
DO - 10.1111/aas.13928
M3 - Journal article
C2 - 34027992
VL - 65
SP - 320
EP - 1328
JO - Acta Anaesthesiologica Scandinavica
JF - Acta Anaesthesiologica Scandinavica
SN - 0001-5172
IS - 9
ER -
ID: 273067716