Efficacy of Phrenic Nerve Block and Suprascapular Nerve Block in Amelioration of Ipsilateral Shoulder Pain after Thoracic Surgery: A Systematic Review and Network Meta-Analysis

Tanyong Pipanmekaporn; Prangmalee Leurcharusmee; Yodying Punjasawadwong; Jiraporn Khorana; Artid Samerchua; Wariya Sukhupragarn; Isaraporn Sukuam; Nutchanart Bunchungmongkol; Surasak Saokaew

doi:10.3390/medicina59020275

Efficacy of Phrenic Nerve Block and Suprascapular Nerve Block in Amelioration of Ipsilateral Shoulder Pain after Thoracic Surgery: A Systematic Review and Network Meta-Analysis

Medicina (Kaunas). 2023 Jan 31;59(2):275. doi: 10.3390/medicina59020275.

Authors

Affiliations

¹ Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
² Clinical Epidemiology and Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
³ Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
⁴ Maeramat Hospital, Maeramat District, Tak 63140, Thailand.
⁵ Unit of Excellence on Clinical Outcomes Research and IntegratioN (UNICORN), School of Pharmaceutical Sciences, University of Phayao, Phayao 56000, Thailand.
⁶ Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao 56000, Thailand.
⁷ Division of Social and Administrative Pharmacy, Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao 56000, Thailand.

Abstract

Background and Objectives: Ipsilateral shoulder pain (ISP) is a common complication after thoracic surgery. Severe ISP can cause ineffective breathing and impair shoulder mobilization. Both phrenic nerve block (PNB) and suprascapular nerve block (SNB) are anesthetic interventions; however, it remains unclear which intervention is most effective. The purpose of this study was to compare the efficacy and safety of PNB and SNB for the prevention and reduction of the severity of ISP following thoracotomy or video-assisted thoracoscopic surgery. Materials and methods: Studies published in PubMed, Embase, Scopus, Web of Science, Ovid Medline, Google Scholar and the Cochrane Library without language restriction were reviewed from the publication's inception through 30 September 2022. Randomized controlled trials evaluating the comparative efficacy of PNB and SNB on ISP management were selected. A network meta-analysis was applied to estimate pooled risk ratios (RRs) and weighted mean difference (WMD) with 95% confidence intervals (CIs). Results: Of 381 records screened, eight studies were eligible. PNB was shown to significantly lower the risk of ISP during the 24 h period after surgery compared to placebo (RR 0.44, 95% CI 0.34 to 0.58) and SNB (RR 0.43, 95% CI 0.29 to 0.64). PNB significantly reduced the severity of ISP during the 24 h period after thoracic surgery (WMD -1.75, 95% CI -3.47 to -0.04), but these effects of PNB were not statistically significantly different from SNB. When compared to placebo, SNB did not significantly reduce the incidence or severity of ISP during the 24 h period after surgery. Conclusion: This study suggests that PNB ranks first for prevention and reduction of ISP severity during the first 24 h after thoracic surgery. SNB was considered the worst intervention for ISP management. No evidence indicated that PNB was associated with a significant impairment of postoperative ventilatory status.

Keywords: ipsilateral shoulder pain; phrenic nerve block; suprascapular nerve block; thoracotomy; video-assisted thoracoscopic surgery.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Humans
Injections, Intra-Articular
Nerve Block* / adverse effects
Network Meta-Analysis
Pain, Postoperative / prevention & control
Phrenic Nerve
Shoulder Pain
Thoracic Surgery*

Grants and funding

This research received no external funding.