Myofascial Involvement of Supra- and Infraspinatus Muscles Contributes to Ipsilateral Shoulder Pain After Muscle-Sparing Thoracotomy and Video-Assisted Thoracic Surgery

• Published in: Journal of cardiothoracic and vascular anesthesia 2013-12, Vol.27 (6), p.1310-1314
• Main Authors: Ohmori, Aki, MD, Iranami, Hiroshi, MD, PhD, Fujii, Keisuke, MD, PhD, Yamazaki, Akinori, MD, Doko, Yukari, MD
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia & Perioperative Care; Anesthesia, General; Critical Care; Endpoint Determination; Female; Humans; Lung - surgery; Male; Middle Aged; Muscle, Skeletal - physiopathology; Muscular Diseases - etiology; Muscular Diseases - physiopathology; Myofascial Pain Syndromes - complications; Pain Measurement; Pain, Postoperative - etiology; Patient Positioning; postoperative pain; Prospective Studies; Retrospective Studies; shoulder; Shoulder Pain - etiology; thoracic surgery, pain; Thoracic Surgery, Video-Assisted - adverse effects; Thoracic Surgery, Video-Assisted - methods; Thoracotomy - adverse effects; Thoracotomy - methods; Upper Extremity
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2013.03.037

Objective This study examined the hypothesis that ipsilateral upper extremity elevation for muscle-sparing thoracotomy procedures contributes to the postoperative shoulder pain. Design Prospective observational study. Setting Medical center. Participants ASA physical status 1-2 patients undergoing elective lung surgeries including pneumonectomy, lobectomy, and segmentectomy performed through either the anterolateral approach or video-assisted thoracotomy surgery. Interventions Postoperative observation of ipsilateral shoulder pain. Measurements and Main Results Postoperative examinations of sites of shoulder pain (clavicle, anterior, lateral,or posterior aspect of acromion, posterior neck, supraspinatus, infraspinatus, and these entire areas) with or without trigger points, visual analog scale score of wound pain, and requested counts of analgesics. The number of patients who suffered from postoperative shoulder pain was 37 of 70 (52.9%). Demographic data, anterolateral/VATS ratio, VAS scores, and requested counts of rescue analgesics requirement were similar in the groups of patients with and without postoperative shoulder pain. The segmentectomy caused a significantly higher incidence of postoperative shoulder pain compared with other procedures (p < 0.05). The supra- and infraspinatus were significantly higher areas of painful regions compared to the other sites. The 16 of 37 patients (43.2%) with shoulder pain showed defined trigger points in their painful areas. Conclusion These results supported the hypothesis that myofascial involvement contributed, to some extent, to shoulder pain after muscle-sparing thoracotomy with ipsilateral upper extremity elevation.