Of 92 cases of post-thoracotomy muscular only shoulder pain, 83.5% obtained satisfactory pain relief from suprascapular nerve block
Am J Ther. 2010 Mar 3. [Epub ahead of print]
In Select Patients, Ipsilateral Post-thoracotomy Shoulder Pain Relieved by Suprascapular Nerve Block.
Saha S, Brish EL, Lowry AM, Boddu K. abstract here
Post chest (thoracotomy) pains have got to be the worst to deal with. Apparently 50% of post thoracotomy patients can end up with pain:
The Clinical Journal of Pain: March 1996 – Volume 12 – Issue 1 – pp 50-55
Acute Pain after Thoracic Surgery Predicts Long-Term Post-Thoracotomy Pain
Katz, Joel Ph.D.; Jackson, Marla B.A.; Kavanagh, Brian P. M.B.; Sandler, Alan N. M.B.
abstract here
Anything that could treat that would be helpful
Now that’s the good news – now for the bad:
a previous study found these blocks didn’t work:
Anesth Analg. 2002 Jan;94(1):199-202
Suprascapular nerve block for ipsilateral shoulder pain after thoracotomy with
thoracic epidural analgesia: a double-blind comparison of 0.5% bupivacaine and
0.9% saline.
Tan N, Agnew NM, Scawn ND, Pennefather SH, Chester M, Russell GN.
free article here The difference was, the top article took only those with musculoskeletal finding – local disease. I wonder if these were early frozen shoulders as suprascapular nerve blocks work for that according to a Montreal study:
J Rheumatol. 2000 Jun;27(6):1464-9.
Double blind randomized clinical trial examining the efficacy of bupivacaine
suprascapular nerve blocks in frozen shoulder.
Dahan TH, Fortin L, Pelletier M, Petit M, Vadeboncoeur R, Suissa S.
abstract here
There were THREE shots:
“a 64% reduction in pain in the treatment group versus 13% in the placebo group was observed at one month as measured by the MPQ multidimensional pain descriptors score (p = 0.03)”
I would have thought results could have been even better if they had had therapy to take out Deltoid and Subscapularis knots and work the shoulder tip.
Maybe looking for a tender coracoid, seen in frozen shoulder could help differentiate as per article here:
Frozen Shoulder Simple Test – Coracoid Tenderness here
Suprascapular Nerve Block:
I prefer a technique injecting on top in trapezius and injection toward the anterior side of the scapular:
Reg Anesth Pain Med. 2007 Nov-Dec;32(6):488-94.
Modified lateral block of the suprascapular nerve: a safe approach and how much
to inject? A morphological study.
Feigl GC, Anderhuber F, Dorn C, Pipam W, Rosmarin W, Likar R. abstract here
- depression of lateral border clavicle, and acromion near acromioclavicular joint
- inject 20 degrees from vertical,go medially and posteriorly
- Hit scapula edge and go anterior to.
- Aim for near scapular notch where may encounter paresthesia
- The found 5 mls was enough to anesthetize area
having been unfortunate enough to have had 2 thoracotomies i can assure you all that the pain afterwards is like nothing on earth…it is truly awful..further to this my first operation was an emergency and the pain relief post op was terrible and left me in agony which was to continue to this very day albeit not has intense but coming on in waves with gripping force that puts you completely out of action until it as subsided…..some 5 yrs after the first op i had the same again to reduce and divide extensive adhesions to my chest wall and diaphragm….i would urge all you pain doctors out there to realise that the pain is awful and needs addressing from the very start…had i been given adequate pain relief at the start i would have been able to cope with life a lot better..has it was i lost my career through being off work due to the pain levels i was enduring…….the patient knows his/her body better than anyone and should be listened to and not dismissed as seeking meds for pleasure…the first time i was given morphine for my pain relief was like being given a new body so great was the relief i felt…whats the big deal with meds anyway? if they are needed then they should be given simple as that….morphine is slowly enabling me to at least have a quality of life not previously possible…i had nerve blocks and everything else that was about but not opiates….what nonsense…if they are needed then prescribe them!!