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2 results

  • Chapter 19 - Adhesive Capsulitis of the Shoulder

  • from Part V - Extremities
  • Edited by Omar Viswanath, Creighton University, Omaha, Ivan Urits, Southcoast Brain & Spine Center, Wareham
  • Book:
    Cambridge Handbook of Pain Medicine
    Published online:
    01 December 2023
    Print publication:
    14 December 2023, pp 146-156

  • Summary

    Adhesive capsulitis is a common cause of shoulder pain and disability, affecting nearly 2% of the general population. It is present in approximately 20% of all diabetics, highly correlated with several other systemic conditions and predispositions, yet is still idiopathic in etiology. Diffuse, insidious onset of shoulder pain with no known trauma is seen in early disease, while symptoms of later disease are dominated by a progressive stiffening that restricts multiple planes of movement. Adhesive capsulitis is primarily managed conservatively with oral anti-inflammatories, local injections, and physical therapy, and the majority of patients achieve spontaneous resolution of symptoms within one to three years. While not conclusively superior to less invasive measures, manipulation under anesthesia and arthroscopic capsulotomy are viable alternatives to patients refractory to conservative therapies.

  • Ipsilateral shoulder pain after thoracotomy surgery: a prospective, randomized, double-blind, placebo-controlled evaluation of the efficacy of infiltrating the phrenic nerve with 0.2%wt/vol ropivacaine

  • G. Danelli, M. Berti, A. Casati, A. Bobbio, D. Ghisi, R. Mele, E. Rossini, G. Fanelli
  • Journal:
    European Journal of Anaesthesiology / Volume 24 / Issue 7 / July 2007
    Published online by Cambridge University Press:
    01 July 2007, pp. 596-601
    Print publication:
    July 2007
  • Background

    The aim of this prospective, randomized, double-blind, placebo-controlled study was to evaluate the efficacy of phrenic nerve infiltration with ropivacaine 0.2% on the incidence and severity of ipsilateral shoulder pain after thoracotomy in patients receiving continuous thoracic epidural analgesia.

    Methods

    Fifty ASA physical status II–III patients, receiving thoracic epidural analgesia for post-thoracotomy pain, were randomly allocated to receive infiltration of the ipsilateral phrenic nerve with either ropivacaine 0.2% 10 mL (ropivacaine, n = 25), or saline 0.9% (control, n = 25) just before lung expansion and chest closure. A blinded observer recorded the incidence and severity of ipsilateral shoulder pain 6, 12, 24, 36 and 48 h after surgery. Postoperative respiratory function was also evaluated with blood gas analyses.

    Results

    The cumulative incidences of ipsilateral shoulder pain during the first 24 h after surgery were 8/25 in the ropivacaine and 16/25 in the control groups (P = 0.047), with median (range) onset times for shoulder pain of 2 (2–24) h with ropivacaine and 0.5 (0.5–24) h in controls (P = 0.005). No differences were reported on the second postoperative day. The areas under the curves of the amount of pain over time were 0 (0–2760) mm h for the ropivacaine and 350 (0–1900) mm h for the control groups (P = 0.06). Postoperatively, similar reductions in indices of oxygenation were observed in both groups.

    Conclusions

    Phrenic nerve infiltration with ropivacaine 0.2% 10 mL reduced the incidence and delayed the onset of ipsilateral shoulder pain during the first 24 h after open lung resection, with no clinically relevant effects on respiratory function.