Effect of Intraoperative Phrenic Nerve Infiltration on Postoperative Ipsilateral Shoulder Pain After Thoracic Surgeries: A Systematic Review and Meta-Analysis of Randomized Controlled Studies
URL: https://www.jcvaonline.com/article/S1053-0770(22)00277-4/fulltext
DOI: 10.1053/j.jvca.2022.04.016
Published: Journal of Cardiothoracic and Vascular Anesthesia, April 12, 2022
Authors: Yi-An Hung, Cheuk-Kwan Sun, Min-Hsien Chiang, Jui-Yi Chen, Ching-Chung Ko, Chih-Chun Chen, Yu Chen, I-Chia Teng, Kuo-Chuan Hung
Article description
Summary:
- The meta-analysis aim was to determine the efficacy of Phrenic Nerve Infiltration (PNI) as the analgesia method to reduce Ipsilateral Shoulder pain (ISP) following thoracic surgery;
- Systematic review and meta-analysis of randomised controlled trials;
- The study included 6 RCTs with a study population size of 482 patients, four low and two uncertain risks of bias;
- Primary outcomes showed a significantly lower overall risk ratio (RR) of ISP in the PNI group than in the control group (RR: 0.46, 95% CI: 0.34-0.61, p < 0.00001, I2 = 19% p = 0.29);
- Subgroup analysis showed no significant difference between approaches of thoracic surgeries or local anaesthetics on the incidence of ISP;
- Secondary outcomes revealed a significantly lower incidence of ISP in the PNI group than in the control group at postoperative 6, 24, and 48 hours.
Conclusions:
- Phrenic nerve infiltration before chest closure reduces the incidence and severity of ipsilateral shoulder pain;
- Further studies are needed to determine the benefits and risks for patients with impaired pulmonary function.
