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

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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

Keywords

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

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