Ipsilateral shoulder pain after thoracotomy with epidural analgesia: the influence of phrenic nerve infiltration with lidocaine.


UNLABELLED:Patients receiving effective thoracic epidural analgesia for postthoracotomy pain may still complain of severe ipsilateral shoulder pain. The etiology of this pain is unclear. In this randomized, double-blinded, placebo-controlled study, we investigated the effect of phrenic nerve infiltration with lidocaine or saline on postoperative shoulder pain in 48 patients. After completion of a lung resection, patients received either 10 mL of 1% lidocaine or 10 mL of 0.9% saline infiltrated into the periphrenic fat pad at the level of the diaphragm. Shoulder pain was experienced by 33% of patients receiving lidocaine, compared with 85% of patients receiving saline (P < 0.008). Overall pain scores were lower with lidocaine (P < 0.05). PaCO(2) values were not significantly higher with lidocaine in the first 2 h. We conclude that pain transmitted via the phrenic nerve and referred to the shoulder is the most likely explanation for the ipsilateral shoulder pain experienced by patients receiving epidural analgesia for postthoracotomy pain. IMPLICATIONS:Ipsilateral shoulder pain after thoracotomy is common and may be severe, even in the presence of a functioning thoracic epidural. We have shown that infiltration of the phrenic nerve with local anesthetic significantly and safely reduces this shoulder pain, potentially allowing the ideal goal of a pain-free thoracotomy.


Anesth Analg


Anesthesia and analgesia


Scawn ND,Pennefather SH,Soorae A,Wang JY,Russell GN




Has Abstract


2001-08-01 00:00:00


260-4, 1st contents page










  • A comparison of peripheral skin blood flow and temperature during endoscopic thoracic sympathotomy.

    abstract::The assessment of sympathetic denervation to the upper extremities during surgery for hyperhidrosis is essential in predicting postoperative outcome, particularly for endoscopic thoracic chain sympathotomy, a recently described, minimally destructive technique that minimizes postoperative compensatory hyperhidrosis. T...

    journal_title:Anesthesia and analgesia

    pub_type: 临床试验,杂志文章


    authors: Eisenach JH,Pike TL,Wick DE,Dietz NM,Fealey RD,Atkinson JL,Charkoudian N

    更新日期:2005-01-01 00:00:00

  • Inhaled nitric oxide reduces pulmonary vascular resistance more than prostaglandin E(1) during heart transplantation.

    abstract:UNLABELLED:Heart transplantation in patients with increased pulmonary vascular resistance is often associated with postbypass right heart failure. We therefore compared the abilities of prostaglandin E(1) (PGE(1)) and inhaled nitric oxide to reduce pulmonary vascular resistance during heart transplantation. Patients un...

    journal_title:Anesthesia and analgesia

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Rajek A,Pernerstorfer T,Kastner J,Mares P,Grabenwöger M,Sessler DI,Grubhofer G,Hiesmayr M

    更新日期:2000-03-01 00:00:00

  • Neuromuscular effects of succinylcholine on the vocal cords and adductor pollicis muscles.

    abstract::To quantify the effects of succinylcholine at the laryngeal adductor muscles and the adductor pollicis, 17 adult patients were studied during propofol-fentanyl anesthesia. Train-of-four stimulation was applied to the ulnar nerve at the wrist and the recurrent laryngeal nerve at the notch of the thyroid cartilage. Lary...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Meistelman C,Plaud B,Donati F

    更新日期:1991-09-01 00:00:00

  • The pharmacodynamic effects of a lower-lipid emulsion of propofol: a comparison with the standard propofol emulsion.

    abstract:UNLABELLED:Using a randomized, double-blind protocol design, we compared a new lower-lipid emulsion of propofol (Ampofol) containing propofol 1%, soybean oil 5%, and egg lecithin 0.6% with the most commonly used formulation of propofol (Diprivan) with respect to onset of action and recovery profiles, as well as intraop...

    journal_title:Anesthesia and analgesia

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Song D,Hamza M,White PF,Klein K,Recart A,Khodaparast O

    更新日期:2004-03-01 00:00:00

  • Safety of the LMA®Gastro™ for Endoscopic Retrograde Cholangiopancreatography.

    abstract:BACKGROUND:Endoscopic retrograde cholangiopancreatography (ERCP) patients typically receive either tubeless anesthesia or general endotracheal anesthesia (GETA). Patients receiving propofol-based total intravenous anesthesia (TIVA) are at higher risk of sedation-related adverse events (SRAEs) than patients receiving GE...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Hagan KB,Carlson R,Arnold B,Nguyen L,Lee J,Weston B,Hernandez M,Feng L,Syed T,Hagberg CA

    更新日期:2020-11-01 00:00:00

  • The interaction of FK409, a novel nitric oxide releaser, and peripherally administered morphine during experimental inflammation.

    abstract:UNLABELLED:Nitric oxide (NO) may play an important role in central and peripheral nociceptive processes. However, its contribution to peripheral antinociception is still not clear. In the present study, we investigated the effect of peripherally administered FK409, a spontaneous NO releaser, and its interaction with pe...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Nozaki-Taguchi N,Yamamoto T

    更新日期:1998-02-01 00:00:00

  • The effects of intravenous lidocaine administration on the minimum alveolar concentration of isoflurane in cats.

    abstract::Lidocaine decreases the minimum alveolar concentration (MAC) of inhaled anesthetics and has been used clinically to reduce the requirements for other anesthetic drugs. In this study we examined the effects of lidocaine on isoflurane MAC in cats. Six cats were studied. In Experiment 1, the MAC of isoflurane was determi...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Pypendop BH,Ilkiw JE

    更新日期:2005-01-01 00:00:00

  • Effect of isoflurane on neuronal apoptosis in rats subjected to focal cerebral ischemia.

    abstract:UNLABELLED:Although isoflurane can reduce ischemic neuronal injury after short postischemic recovery intervals, this neuroprotective efficacy is not sustained. Neuronal apoptosis can contribute to the gradual increase in infarct size after ischemia. This suggests that isoflurane, although capable of reducing early neur...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Kawaguchi M,Drummond JC,Cole DJ,Kelly PJ,Spurlock MP,Patel PM

    更新日期:2004-03-01 00:00:00

  • Complement activation and cardiac surgery: a novel target for improving outcomes.

    abstract::Complement activation and the resulting inflammatory response is an important potential mechanism for multisystem organ injury in cardiac surgery. Novel therapeutic strategies using complement inhibitors may hold promise for improving outcomes for cardiac surgical patients by attenuating complement activation or its b...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章,评审


    authors: Stahl GL,Shernan SK,Smith PK,Levy JH

    更新日期:2012-10-01 00:00:00

  • A novel infraclavicular brachial plexus block: the lateral and sagittal technique, developed by magnetic resonance imaging studies.

    abstract:UNLABELLED:A new infraclavicular brachial plexus block method has the patient supine with an adducted arm. The target is any of the three cords behind the pectoralis minor muscle. The point of needle insertion is the intersection between the clavicle and the coracoid process. The needle is advanced 0 degrees -30 degree...

    journal_title:Anesthesia and analgesia

    pub_type: 临床试验,杂志文章


    authors: Klaastad Ø,Smith HJ,Smedby O,Winther-Larssen EH,Brodal P,Breivik H,Fosse ET

    更新日期:2004-01-01 00:00:00

  • Venous air embolism prophylaxis with a surface-active agent.

    abstract::The protective effect of a nonionic surface-active polyol agent (Pluronic F-68) against bolus injection and constant-rate IV infusion of air was studied in 21 dogs anesthetized with pentobarbital. Aortic, pulmonary artery and right ventricular pressures, cardiac output, end-tidal CO2 concentration, wasted ventilation,...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Perry JC,Munson ES,Malagodi MH,Shah DO

    更新日期:1975-11-01 00:00:00

  • Role of the Perioperative Surgical Home in Optimizing the Perioperative Use of Opioids.

    abstract::Several federal agencies have recently noted that the United States is in the midst of an unprecedented "opioid epidemic," with an increasing number of opioid-related overdoses and deaths. Providers currently face 3 population-level, public health challenges in providing optimal perioperative pain care: (1) the contin...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章,评审


    authors: Vetter TR,Kain ZN

    更新日期:2017-11-01 00:00:00

  • Positive end-expiratory pressure improves survival in a rodent model of cardiopulmonary resuscitation using high-dose epinephrine.

    abstract:BACKGROUND:Multiple interventions have been tested in models of cardiopulmonary resuscitation (CPR) to optimize drug use, chest compressions, and ventilation. None has studied the effects of positive end-expiratory pressure (PEEP) on outcome. We hypothesized that because PEEP can reverse pulmonary atelectasis, lower pu...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: McCaul C,Kornecki A,Engelberts D,McNamara P,Kavanagh BP

    更新日期:2009-10-01 00:00:00

  • The effect of erythromycin, fluvoxamine, and their combination on the pharmacokinetics of ropivacaine.

    abstract:UNLABELLED:We studied the effect of fluvoxamine and erythromycin on the pharmacokinetics of ropivacaine in a double-blinded, randomized, four-way cross-over study. Eight healthy volunteers ingested daily 1500 mg erythromycin for 6 days, 100 mg fluvoxamine for 5 days (Days 2-6), both erythromycin and fluvoxamine, or pla...

    journal_title:Anesthesia and analgesia

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Jokinen MJ,Ahonen J,Neuvonen PJ,Olkkola KT

    更新日期:2000-11-01 00:00:00

  • Neostigmine Versus Sugammadex for Reversal of Neuromuscular Blockade and Effects on Reintubation for Respiratory Failure or Newly Initiated Noninvasive Ventilation: An Interrupted Time Series Design.

    abstract:BACKGROUND:Pulmonary complications related to residual neuromuscular blockade lead to morbidity and mortality. Using an interrupted time series design, we tested whether proportions of reintubation for respiratory failure or new noninvasive ventilation were changed after a system-wide transition of the standard reversa...

    journal_title:Anesthesia and analgesia

    pub_type: 临床试验,杂志文章


    authors: Krause M,McWilliams SK,Bullard KJ,Mayes LM,Jameson LC,Mikulich-Gilbertson SK,Fernandez-Bustamante A,Bartels K

    更新日期:2020-07-01 00:00:00

  • Clinical trial of a new device for fiberoptic orotracheal intubation (Augustine Scope).

    abstract::Blind oral intubation using the Augustine Guide is helpful for intubating the trachea of patients presenting with difficult airways. This device has been modified by adding a fiberoptic scope with a built-in battery-powered light. We studied this Augustine Scope in 104 patients (Group AS) and compared the results with...

    journal_title:Anesthesia and analgesia

    pub_type: 临床试验,杂志文章


    authors: Krafft P,Krenn CG,Fitzgerald RD,Pernerstorfer T,Fridrich P,Weinstabl C

    更新日期:1997-03-01 00:00:00

  • Forearm compartment syndrome from intravenous mannitol extravasation during general anesthesia.

    abstract:IMPLICATIONS:Complications of IV mannitol administration resulting in compartment syndrome may warrant surgical intervention. Compartment syndrome is difficult to diagnose in the anesthetized patient. Infusing mannitol in an observed IV site permits discontinuation of mannitol before complications ensue. Early recognit...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Edwards JJ,Samuels D,Fu ES

    更新日期:2003-01-01 00:00:00

  • A Retrospective Analysis of Clinical Research Misconduct Using FDA-Issued Warning Letters and Clinical Investigator Inspection List From 2010 to 2014.

    abstract:BACKGROUND:The US Food and Drug Administration (FDA) conducts inspections of clinical investigation sites as a component of clinical trial regulation. The FDA describes the results of these inspections in the Clinical Investigator Inspection List (CLIIL). More serious violations are followed up in FDA warning letters i...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Romano CA,Nair S,Delphin ES

    更新日期:2018-03-01 00:00:00

  • The effects of milrinone on platelets in patients undergoing cardiac surgery.

    abstract::Although amrinone produces thrombocytopenia, no information is available regarding the acute effects of milrinone on platelets. Therefore, we evaluated the effects of milrinone on platelet number and function in cardiac surgical patients. Twenty-seven patients were studied during cardiac surgery requiring cardiopulmon...

    journal_title:Anesthesia and analgesia

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Kikura M,Lee MK,Safon RA,Bailey JM,Levy JH

    更新日期:1995-07-01 00:00:00

  • Glymphatic System Function in Relation to Anesthesia and Sleep States.

    abstract::The brain is one of the most metabolically active organs in the body. The brain's high energy demand associated with wakefulness persists during rapid eye movement sleep, and even during non-rapid eye movement sleep, cerebral oxygen consumption is only reduced by 20%. The active bioenergetic state parallels metabolic ...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章,评审


    authors: Benveniste H,Heerdt PM,Fontes M,Rothman DL,Volkow ND

    更新日期:2019-04-01 00:00:00

  • A Prospective, Ex Vivo Trial of Endobronchial Blockade Management Utilizing 3 Commonly Available Bronchial Blockers.

    abstract:BACKGROUND:Lung isolation with bronchial blockers is a well-described and accepted procedure, often described for use during the management of massive hemoptysis. Recommendations for balloon inflation are sparse, with some advocating for saline whereas other suggest air, including the manufacturers. We sought to evalua...

    journal_title:Anesthesia and analgesia

    pub_type: 临床试验,杂志文章


    authors: Gilbert CR,Mallow C,Wishire CL,Chang SC,Yarmus LB,Vallieres E,Haeck K,Gorden JA

    更新日期:2019-12-01 00:00:00

  • The Effect of "Opt-Out" Regulation on Access to Surgical Care for Urgent Cases in the United States: Evidence from the National Inpatient Sample.

    abstract:BACKGROUND:In 2001, the Center for Medicare and Medicaid Services issued a rule permitting states to "opt-out" of federal regulations requiring physician supervision of nurse anesthetists. We examined the extent to which this rule increased access to anesthesia care for urgent cases. METHODS:Using data from a national...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Sun E,Dexter F,Miller TR

    更新日期:2016-06-01 00:00:00

  • Fresh-Frozen Plasma: Ordering Patterns and Utilization in the Operating Rooms of a Tertiary Referral Hospital.

    abstract:BACKGROUND:Blood product transfusion is the most commonly performed hospital procedure. Intraoperative blood product utilization varies between institutions and anesthesiologists. In the United States in 2011, nearly 4 million plasma units were transfused. METHODS:A retrospective analysis of intraoperative plasma orde...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Meyer MJ,Dzik WH,Levine WC

    更新日期:2017-02-01 00:00:00

  • Transfer and uptake of alfentanil in the human placenta during in vitro perfusion.

    abstract::Alfentanil, a short-acting lipophilic opioid, is used for labor analgesia and cesarean section and may cause neonatal depression. However, direct placental alfentanil transfer has not been studied. We measured placental alfentanil transfer and uptake during in vitro perfusion. Placenta lobules from healthy parturients...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Zakowski MI,Ham AA,Grant GJ

    更新日期:1994-12-01 00:00:00

  • Case report: profound hypotension after anesthetic induction with propofol in patients treated with rifampin.

    abstract::Rifampin is commonly used for the treatment of tuberculosis and staphylococcal infections, as well as for prevention of infection in cardiac valve and bone surgeries. We report a case of profound hypotension after anesthesia induction with propofol in a patient who was treated with two 600 mg doses of rifampin for pro...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Mirzakhani H,Nozari A,Ehrenfeld JM,Peterfreund R,Szabo M,Walsh JL,Jiang Y,Sandberg W,Rosow C,Wang J

    更新日期:2013-07-01 00:00:00

  • Autonomous Systems in Anesthesia: Where Do We Stand in 2020? A Narrative Review.

    abstract::As most of us are aware, almost every facet of our society is becoming, for better or worse, progressively more technology-dependent. Technological advancement has made autonomous systems, also known as robots, an integral part of our life in several fields, including medicine. The application of robots in anesthesia ...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章,评审


    authors: Zaouter C,Joosten A,Rinehart J,Struys MMRF,Hemmerling TM

    更新日期:2020-05-01 00:00:00

  • The relationship between cardiac output measured by the thermodilution method and that measured by the carbon dioxide rebreathing technique during laparoscopic surgery.

    abstract::Carbon dioxide insufflation during laparoscopic surgery may interfere with the accuracy of the cardiac output value measured by the NICO2 system. The authors simultaneously measured cardiac output by the thermodilution method and by the carbon dioxide rebreathing technique during laparoscopic adrenalectomy in a patien...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Suzuki M,Koda S,Nakamura Y,Kawamura N,Shimada Y

    更新日期:2005-05-01 00:00:00

  • Avoiding transfusions in children undergoing cardiac surgery: a meta-analysis of randomized trials of aprotinin.

    abstract::Aprotinin, a potent antifibrinolytic drug, reduces the proportion of adults who receive blood transfusions during cardiac surgery, although the effect in children remains unclear. We performed a systematic review of the literature to identify all English language, randomized controlled trials of aprotinin involving ch...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章,meta分析


    authors: Arnold DM,Fergusson DA,Chan AK,Cook RJ,Fraser GA,Lim W,Blajchman MA,Cook DJ

    更新日期:2006-03-01 00:00:00

  • Supplemental oxygen does not reduce myocardial ischemia in premedicated patients with critical coronary artery disease.

    abstract::This randomized, prospective clinical study investigated the effects of supplemental inspired oxygen on arterial hemoglobin desaturation and myocardial ischemia in premedicated patients who have critical coronary artery stenosis, identified predictors for these adverse events, and examined the temporal relationship be...

    journal_title:Anesthesia and analgesia

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Kavanagh BP,Cheng DC,Sandler AN,Chung F,Lawson S,Ong D

    更新日期:1993-05-01 00:00:00

  • Sevoflurane or halothane anesthesia: can we tell the difference?

    abstract:UNLABELLED:This study was performed to evaluate the ability of anesthesiologists to differentiate between sevoflurane, a newer, more expensive anesthetic, and halothane. A total of 113 assessments were made by 36 anesthesiologists on 58 children, aged 6 mo to 6 yr, scheduled for bilateral myringotomy and tube placement...

    journal_title:Anesthesia and analgesia

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Bacher A,Burton AW,Uchida T,Zornow MH

    更新日期:1997-12-01 00:00:00