• Morten R Blichfeldt-Eckhardt, Claus Andersen, Helle Ørding, Peter B Licht, and Palle Toft.
• Department of Anesthesiology, Vejle Hospital, DK-7100 Vejle, Denmark; Departments of Anesthesiology and Intensive Care Odense, Denmark. Electronic address: mr.be@rsyd.dk.
• J. Cardiothorac. Vasc. Anesth. 2017 Feb 1; 31 (1): 147-151.

ObjectivesTo study the time course of ipsilateral shoulder pain after thoracic surgery with respect to incidence, pain intensity, type of pain (referred versus musculoskeletal), and surgical approach.DesignProspective, observational cohort study.SettingOdense University Hospital, Denmark.ParticipantsSixty patients for major lung resection.InterventionsPostoperative observation of ipsilateral shoulder pain.Measurements And Main ResultsPostoperative numeric rating scale score of shoulder pain and thoracic pain and postoperative examination of the sites of shoulder pain for musculoskeletal involvement (muscle tenderness on palpation and movement) with follow-up 12 months after surgery. Clinically relevant pain was defined as a numeric rating scale score>3. Of the 60 patients included, 47 (78%) experienced ipsilateral shoulder pain, but only 25 (42%) reported clinically relevant shoulder pain. On postoperative day 4, 19 patients (32%) still suffered shoulder pain, but only 4 patients (7%) had clinically relevant pain. Four patients (8%) still suffered shoulder pain 12 months after surgery. In 26 patients (55%), the shoulder pain was classified as referred versus 21 patients (45%) who suffered shoulder pain of the musculoskeletal type. Shoulder pain of the musculoskeletal type was significantly more intense (p = 0.0008) than referred shoulder pain.ConclusionOnly a subset of patients has clinically relevant shoulder pain after postoperative day 2. Chronic shoulder pain is a minor problem after lobectomy and previously may have been overestimated. Ipsilateral shoulder pain of the musculoskeletal type is more intense than referred ipsilateral shoulder pain.Copyright © 2017 Elsevier Inc. All rights reserved.

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