This study aims to compare the frequency of occurrence of ipsilateral shoulder pain in patients undergoing thoracotomy with ultrasound-guided interscalene block, anterior suprascapular block as adjunct to epidural and epidural block only.
Thoracotomy is one type of surgery associated with challenging pain that needs to be promptly addressed to avoid post-operative respiratory complications and aid in effective postoperative physiotherapy and patient recovery. Epidural analgesia is considered the gold standard for the thoracotomy procedure. Ipsilateral shoulder pain (ISP) following thoracotomy has an incidence ranging from 37% to 85%. Being so common, this pain needs more attention and proper anticipation, and management. ISP is usually non-responsive to the effects of epidural and paravertebral blocks.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
75
Patients will receive an ultrasound-guided interscalene block.
Patients will receive an ultrasound-guided anterior suprascapular block.
Patients will not receive regional blocks apart from epidural analgesia.
Cairo University
Cairo, Egypt
RECRUITINGFrequency of occurrence of ipsilateral shoulder pain
Frequency of occurrence of ipsilateral shoulder pain will be recorded.
Time frame: 72 hours postoperatively
Degree of pain
Each patient will be instructed about postoperative pain assessment with the visual analog scale (VAS). VAS (0 represents "no pain" while 10 represents "the worst pain imaginable"). VAS will be recorded after intensive care unit (ICU) admission then every 6 h postoperative for 72 h.
Time frame: 72 hours postoperatively
Mean arterial pressure
Mean arterial pressure will be recorded every 30 minutes and immediately postoperative then every 4 h postoperative for 48 h.
Time frame: 48 hours postoperatively
Heart rate
Heart rate will be recorded every 30 minutes and immediately postoperative then every 4 h postoperative for 48 h.
Time frame: 48 hours postoperatively
Incidence of complications
Incidence of postoperative complications will be recorded.
Time frame: 72 hours postoperatively
Time to first request of rescue analgesia
Rescue analgesia with 5 ml of 0.25% bupivacaine through the epidural catheter (in case of thoracotomy pain). Ketorolac 30 mg I.V. over 50 cc saline for breakthrough shoulder pain (will not exceed 120 mg/day).
Time frame: 72 hours postoperatively
Total number of rescue analgesia
Total number of rescue analgesia will be recorded.
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Time frame: 72 hours postoperatively
Peak Expiratory Flow Rate
Peak Expiratory Flow Rate (PEFR) will be recorded as baseline in holding area before premedication and every 6 h postoperative for 72 h when visual analog scale (VAS) is ≤ 3.
Time frame: 72 hours postoperatively
Forced Expiratory Volume in 1 second (FEV1)
Forced Expiratory Volume in 1 second (FEV1) will be recorded preoperative and at day 0, 1, 2 \& 3 when visual analog scale (VAS) is ≤ 3.
Time frame: 72 hours postoperatively
Forced vital capacity (FVC)
Forced vital capacity (FVC) will be recorded preoperative and at day 0, 1, 2 \& 3 when visual analog scale (VAS) is ≤ 3.
Time frame: 72 hours postoperatively
Forced Expiratory Volume in 1 second (FEV1) / Forced vital capacity (FVC) ratio
Forced Expiratory Volume in 1 second (FEV1) / Forced vital capacity (FVC) ratio will be recorded preoperative and at day 0, 1, 2 \& 3 when visual analog scale (VAS) is ≤ 3.
Time frame: 72 hours postoperatively