A Randomized Study Comparing the Incidence of Postoperative Pain After Phrenic Nerve Infiltration Vs Nonphrenic Nerve Infiltration During Thoracotomy.

Bhuvaneswari Bibleraaj, WR Critchley, SY Soon, R Birla, Z Begum, J Nair, N Devan, Ram Mohan, James Fildes, J Morris, C Fullwood, P Krysiak, I Malagon, R Shah

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Thoracotomy is a common surgical procedure performed worldwide for lung disease. Despite major advances in analgesia, patients still experience severe shoulder, central back and surgical incision site pain in the postoperative period. This study aimed to assess whether intra-operative phrenic nerve infiltration reduces the incidence of postoperative pain and improves peak flow volume measurements during incentive spirometry. Methods: 90 patients undergoing open lobectomy were randomly assigned to have phrenic nerve infiltration (n=46) or not (n=44). The phrenic nerve infiltration group received 10mls of 0.25% bupivacaine into the periphrenic fat pad. Preoperative assessments of spirometry and pain scores were recorded (at rest and with movement). Postoperative assessments included peak flow and pain measurements at intervals up to 72 hours. Results: Less shoulder pain was experienced with phrenic nerve infiltration up to 6 hours post-surgery at rest (p=0.005) and up to 12 hours with movement (p<0.001). Reduced back pain was reported in the phrenic nerve infiltration group up to 6 hours after surgery both at rest (p=0.001) and with movement (p=0.00). Phrenic nerve infiltration reduced pain at the incision site for up to 3 hours both at rest (p<0.001) and with movement (p=0.001). Spirometry readings dropped in both groups with consistently lower readings at baseline and follow-up in the PNI group (p=0.007). Lower analgesic usage of PCA morphine (p<0.0001), epipleural bupivacaine (p=0.001), and oromorph/zomorph (p=0.0002) were recorded. Conclusion: Our findings indicate that the use of phrenic nerve infiltration significantly reduced patient pain scores during the early post-operative period, particularly during movement. We believe that each technique has advantages and disadvantages, however, further studies with large sample size are warranted.
Original languageEnglish
JournalSeminars in Thoracic and Cardiovascular Surgery
Early online date7 Dec 2018
DOIs
Publication statusE-pub ahead of print - 7 Dec 2018

Fingerprint

Phrenic Nerve
Thoracotomy
Postoperative Pain
Cohort Studies
Spirometry
Bupivacaine
Pain Measurement
Pain
Reading
Shoulder Pain
Passive Cutaneous Anaphylaxis
Back Pain
Postoperative Period
Sample Size
Analgesia
Morphine
Lung Diseases
Analgesics
Adipose Tissue
Motivation

Keywords

  • Phrenic nerve
  • postoperative pain
  • Peak flow pressure
  • bupivacaine infiltration
  • open thoracotomy

Cite this

Bibleraaj, Bhuvaneswari ; Critchley, WR ; Soon, SY ; Birla, R ; Begum, Z ; Nair, J ; Devan, N ; Mohan, Ram ; Fildes, James ; Morris, J ; Fullwood, C ; Krysiak, P ; Malagon, I ; Shah, R. / A Randomized Study Comparing the Incidence of Postoperative Pain After Phrenic Nerve Infiltration Vs Nonphrenic Nerve Infiltration During Thoracotomy. In: Seminars in Thoracic and Cardiovascular Surgery. 2018.
@article{b84b3f8342034d83bfd5c2929ff81487,
title = "A Randomized Study Comparing the Incidence of Postoperative Pain After Phrenic Nerve Infiltration Vs Nonphrenic Nerve Infiltration During Thoracotomy.",
abstract = "Background: Thoracotomy is a common surgical procedure performed worldwide for lung disease. Despite major advances in analgesia, patients still experience severe shoulder, central back and surgical incision site pain in the postoperative period. This study aimed to assess whether intra-operative phrenic nerve infiltration reduces the incidence of postoperative pain and improves peak flow volume measurements during incentive spirometry. Methods: 90 patients undergoing open lobectomy were randomly assigned to have phrenic nerve infiltration (n=46) or not (n=44). The phrenic nerve infiltration group received 10mls of 0.25{\%} bupivacaine into the periphrenic fat pad. Preoperative assessments of spirometry and pain scores were recorded (at rest and with movement). Postoperative assessments included peak flow and pain measurements at intervals up to 72 hours. Results: Less shoulder pain was experienced with phrenic nerve infiltration up to 6 hours post-surgery at rest (p=0.005) and up to 12 hours with movement (p<0.001). Reduced back pain was reported in the phrenic nerve infiltration group up to 6 hours after surgery both at rest (p=0.001) and with movement (p=0.00). Phrenic nerve infiltration reduced pain at the incision site for up to 3 hours both at rest (p<0.001) and with movement (p=0.001). Spirometry readings dropped in both groups with consistently lower readings at baseline and follow-up in the PNI group (p=0.007). Lower analgesic usage of PCA morphine (p<0.0001), epipleural bupivacaine (p=0.001), and oromorph/zomorph (p=0.0002) were recorded. Conclusion: Our findings indicate that the use of phrenic nerve infiltration significantly reduced patient pain scores during the early post-operative period, particularly during movement. We believe that each technique has advantages and disadvantages, however, further studies with large sample size are warranted.",
keywords = "Phrenic nerve, postoperative pain, Peak flow pressure, bupivacaine infiltration, open thoracotomy",
author = "Bhuvaneswari Bibleraaj and WR Critchley and SY Soon and R Birla and Z Begum and J Nair and N Devan and Ram Mohan and James Fildes and J Morris and C Fullwood and P Krysiak and I Malagon and R Shah",
note = "Ref: STCVS_2018_164 PMID:30529157",
year = "2018",
month = "12",
day = "7",
doi = "10.1053/j.semtcvs.2018.11.014",
language = "English",
journal = "Seminars in Thoracic and Cardiovascular Surgery",
issn = "1043-0679",
publisher = "W.B. Saunders Ltd",

}

A Randomized Study Comparing the Incidence of Postoperative Pain After Phrenic Nerve Infiltration Vs Nonphrenic Nerve Infiltration During Thoracotomy. / Bibleraaj, Bhuvaneswari; Critchley, WR; Soon, SY; Birla, R; Begum, Z; Nair, J; Devan, N; Mohan, Ram; Fildes, James; Morris, J; Fullwood, C; Krysiak, P; Malagon, I; Shah, R.

In: Seminars in Thoracic and Cardiovascular Surgery, 07.12.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A Randomized Study Comparing the Incidence of Postoperative Pain After Phrenic Nerve Infiltration Vs Nonphrenic Nerve Infiltration During Thoracotomy.

AU - Bibleraaj, Bhuvaneswari

AU - Critchley, WR

AU - Soon, SY

AU - Birla, R

AU - Begum, Z

AU - Nair, J

AU - Devan, N

AU - Mohan, Ram

AU - Fildes, James

AU - Morris, J

AU - Fullwood, C

AU - Krysiak, P

AU - Malagon, I

AU - Shah, R

N1 - Ref: STCVS_2018_164 PMID:30529157

PY - 2018/12/7

Y1 - 2018/12/7

N2 - Background: Thoracotomy is a common surgical procedure performed worldwide for lung disease. Despite major advances in analgesia, patients still experience severe shoulder, central back and surgical incision site pain in the postoperative period. This study aimed to assess whether intra-operative phrenic nerve infiltration reduces the incidence of postoperative pain and improves peak flow volume measurements during incentive spirometry. Methods: 90 patients undergoing open lobectomy were randomly assigned to have phrenic nerve infiltration (n=46) or not (n=44). The phrenic nerve infiltration group received 10mls of 0.25% bupivacaine into the periphrenic fat pad. Preoperative assessments of spirometry and pain scores were recorded (at rest and with movement). Postoperative assessments included peak flow and pain measurements at intervals up to 72 hours. Results: Less shoulder pain was experienced with phrenic nerve infiltration up to 6 hours post-surgery at rest (p=0.005) and up to 12 hours with movement (p<0.001). Reduced back pain was reported in the phrenic nerve infiltration group up to 6 hours after surgery both at rest (p=0.001) and with movement (p=0.00). Phrenic nerve infiltration reduced pain at the incision site for up to 3 hours both at rest (p<0.001) and with movement (p=0.001). Spirometry readings dropped in both groups with consistently lower readings at baseline and follow-up in the PNI group (p=0.007). Lower analgesic usage of PCA morphine (p<0.0001), epipleural bupivacaine (p=0.001), and oromorph/zomorph (p=0.0002) were recorded. Conclusion: Our findings indicate that the use of phrenic nerve infiltration significantly reduced patient pain scores during the early post-operative period, particularly during movement. We believe that each technique has advantages and disadvantages, however, further studies with large sample size are warranted.

AB - Background: Thoracotomy is a common surgical procedure performed worldwide for lung disease. Despite major advances in analgesia, patients still experience severe shoulder, central back and surgical incision site pain in the postoperative period. This study aimed to assess whether intra-operative phrenic nerve infiltration reduces the incidence of postoperative pain and improves peak flow volume measurements during incentive spirometry. Methods: 90 patients undergoing open lobectomy were randomly assigned to have phrenic nerve infiltration (n=46) or not (n=44). The phrenic nerve infiltration group received 10mls of 0.25% bupivacaine into the periphrenic fat pad. Preoperative assessments of spirometry and pain scores were recorded (at rest and with movement). Postoperative assessments included peak flow and pain measurements at intervals up to 72 hours. Results: Less shoulder pain was experienced with phrenic nerve infiltration up to 6 hours post-surgery at rest (p=0.005) and up to 12 hours with movement (p<0.001). Reduced back pain was reported in the phrenic nerve infiltration group up to 6 hours after surgery both at rest (p=0.001) and with movement (p=0.00). Phrenic nerve infiltration reduced pain at the incision site for up to 3 hours both at rest (p<0.001) and with movement (p=0.001). Spirometry readings dropped in both groups with consistently lower readings at baseline and follow-up in the PNI group (p=0.007). Lower analgesic usage of PCA morphine (p<0.0001), epipleural bupivacaine (p=0.001), and oromorph/zomorph (p=0.0002) were recorded. Conclusion: Our findings indicate that the use of phrenic nerve infiltration significantly reduced patient pain scores during the early post-operative period, particularly during movement. We believe that each technique has advantages and disadvantages, however, further studies with large sample size are warranted.

KW - Phrenic nerve

KW - postoperative pain

KW - Peak flow pressure

KW - bupivacaine infiltration

KW - open thoracotomy

U2 - 10.1053/j.semtcvs.2018.11.014

DO - 10.1053/j.semtcvs.2018.11.014

M3 - Article

JO - Seminars in Thoracic and Cardiovascular Surgery

JF - Seminars in Thoracic and Cardiovascular Surgery

SN - 1043-0679

ER -