Skip to main content

Advertisement

SpringerLink
Log in

Evaluation of postoperative pregabalin for attenuation of postoperative shoulder pain after thoracotomy in patients with lung cancer, a preliminary result

  • Original Article
  • Published:
General Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Objective

Thirty-one to 97 % of patients who undergo thoracotomy for lung cancer experience ipsilateral shoulder pain, marring the otherwise excellent relief provided by thoracic epidural analgesia. The aim of this study was to test whether the addition of pregabalin to the treatment for shoulder pain would provide a significant benefit.

Methods

Twenty patients undergoing thoracic surgery for lung cancer were enrolled in the control group between May 2012 and December 2012, and 20 patients were enrolled in the pregabalin group between January 2013 and July 2013, consecutively. All patients had standard pre- and intraoperative care. Patients received pregabalin 150 mg po POD 1 and then non-steroidal anti-inflammatory drugs (NSAIDs) po 2 h later (pregabalin group), or they received only NSAIDs po at exactly the same times (control group). Pain severity was then measured using a 100-mm visual analog scale (VAS) scoring system.

Results

The VAS scores indicated that patients in the pregabalin group had significantly less shoulder pain on postoperative day (POD) 2 than those in the control group (control: 27.9 ± 28.1 vs. pregabalin: 11.8 ± 14.4; p = 0.030). No differences in pain were observed between the two groups on other POD. There were significant differences on only POD 2 in the patients with shoulder pain immediately after surgery. Three of the pregabalin-treated patients showed mild somnolence.

Conclusions

Postoperative administration of pregabalin provided significant relief of postoperative shoulder pain during earlier POD after thoracic surgery for lung cancer when received multimodal analgesia in combination with NSAIDs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Burgess FW, Anderson DM, Colonna D, Sborov MJ, Cavanaugh DG. Ipsilateral shoulder pain following thoracic surgery. Anesthesiology. 1993;78:365–8.

    Article  CAS  PubMed  Google Scholar 

  2. Barak M, Ziser A, Katz Y. Thoracic epidural local anesthetics are ineffective in alleviating post-thoracotomy ipsilateral shoulder pain. J Cardiothorac Vasc Anesth. 2004;18:458–60.

    Article  CAS  PubMed  Google Scholar 

  3. Mac TB, Girard F, Chouinard P, Boudreault D, Lafontaine ER, Ruel M, et al. Acetaminophen decreases early post-thoracotomy ipsilateral shoulder pain in patients with thoracic epidural analgesia: a double-blind placebo-controlled study. J Cardiothorac Vasc Anesth. 2005;19:475–8.

    Article  CAS  PubMed  Google Scholar 

  4. Pennefather SH, Akrofi ME, Kendall JB, Russell GN, Scawn ND. Double-blind comparison of intrapleural saline and 0.25% bupivacaine for ipsilateral shoulder pain after thoracotomy in patients receiving thoracic epidural analgesia. Br J Anaesth. 2005;94:234–8.

    Article  CAS  PubMed  Google Scholar 

  5. Scawn ND, Pennefather SH, Soorae A, Wang JY, Russell GN. Ipsilateral shoulder pain after thoracotomy with epidural analgesia: the influence of phrenic nerve infiltration with lidocaine. Anesth Analg. 2001;93:260–4.

    CAS  PubMed  Google Scholar 

  6. Tan N, Agnew NM, Scawn ND, Pennefather SH, Chester M, Russell GN. 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. Anesth Analg. 2002;94:199–202.

    CAS  PubMed  Google Scholar 

  7. Mackenzie J. Symptoms and their interpretation. London: Shaw; 1909.

    Google Scholar 

  8. Ruch TC. Visceral sensation and referred pain. In: Fulton JF, editor. Howell’s textbook of physiology. 15th ed. Philadelphia: WB Saunders; 1946. p. 385–401.

    Google Scholar 

  9. Ng KP, Chow YF. Brachial plexus block for ipsilateral shoulder pain after thoracotomy. Anaesth Intensive Care. 1997;25:74–6.

    CAS  PubMed  Google Scholar 

  10. Barak M, Iaroshevski D, Poppa E, Ben-Nun A, Katz Y. Low-volume interscalene brachial plexus block for post-thoracotomy shoulder pain. J Cardiothorac Vasc Anesth. 2007;21:554–7.

    Article  PubMed  Google Scholar 

  11. Urmey WF, McDonald M. Hemidiaphragmatic paresis during interscalene brachial plexus block: effects on pulmonary function and chest wall mechanics. Anesth Analg. 1992;74:352–7.

    Article  CAS  PubMed  Google Scholar 

  12. Dooley DJ, Donovan CM, Meder WP, Whetzel SZ. Preferential action of gabapentin and pregabalin at P/Q-type voltage-sensitive calcium channels: inhibition of K + -evoked [3H]-norepinephrine release from rat neocortical slices. Synapse. 2002;45:171–90.

    Article  CAS  PubMed  Google Scholar 

  13. Guay DR. Pregabalin in neuropathic pain: a more ‘pharmaceutically elegant’ gabapentin? Am J Geriatr Pharmacother. 2005;3:274–87.

    Article  CAS  PubMed  Google Scholar 

  14. Frampton JE, Foster RH. Pregabalin: in the treatment of postherpetic neuralgia. Drugs. 2005;65:111–8.

    Article  PubMed  Google Scholar 

  15. Dworkin RH, Corbin AE, Young JP Jr, Sharma U, LaMoreaux L, Bockbrader H, et al. Pregabalin for the treatment of postherpetic neuralgia: a randomized, placebo-controlled trial. Neurology. 2003;60:1274–83.

    Article  CAS  PubMed  Google Scholar 

  16. Sabatowski R, Gálvez R, Cherry DA, Jacquot F, Vincent E, Maisonobe P, 1008–045 Study Group, et al. Pregabalin reduces pain and improves sleep and mood disturbances in patients with post-herpetic neuralgia: results of a randomised, placebo-controlled clinical trial. Pain. 2004;109:26–35.

    Article  CAS  PubMed  Google Scholar 

  17. Tolle T, Freynhagen R, Versavel M, Trostmann U, Young JP Jr. Pregabalin for relief of neuropathic pain associated with diabetic neuropathy: a randomized, double-blind study. Eur J Pain. 2008;12:203–13.

    Article  PubMed  Google Scholar 

  18. Zhang J, Ho KY, Wang Y. Efficacy of pregabalin in acute postoperative pain: a meta-analysis. Br J Anaesth. 2011;106:454–62.

    Article  CAS  PubMed  Google Scholar 

  19. Kehlet H, Dahl JB. The value of “multimodal” or “balanced analgesia” in postoperative pain treatment. Anesth Analg. 1993;77:1048–56.

    Article  CAS  PubMed  Google Scholar 

  20. White PF. The changing role of non-opioid analgesic techniques in the management of postoperative pain. Anesth Analg. 2005;101:S5–22.

    Article  PubMed  Google Scholar 

  21. Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg. 2008;248:189–98.

    Article  PubMed  Google Scholar 

  22. Salomaki TE, Laitinen JO, Nuutinen LS. A randomized double-blind comparison of epidural versus intravenous fentanyl infusion for analgesia after thoracotomy. Anesthesiology. 1991;75:790–5.

    Article  CAS  PubMed  Google Scholar 

  23. Brunton LM, Laporte DM. Use of gabapentin and pregabalin for hand surgery patients. J Hand Surg Am. 2012;37:1486–8.

    Article  PubMed  Google Scholar 

  24. Huot MP, Chouinard P, Girard F, Ruel M, Lafontaine ER, Ferraro P. Gabapentin does not reduce post-thoracotomy shoulder pain: a randomized, double-blind placebo-controlled study. Can J Anaesth. 2008;55:337–43.

    Article  PubMed  Google Scholar 

  25. Bockbrader HN, Wesche D, Miller R, Chapel S, Janiczek N, Burger P. A comparison of the pharmacokinetics and pharmacodynamics of pregabalin and gabapentin. Clin Pharmacokinet. 2010;49:661–9.

    Article  CAS  PubMed  Google Scholar 

  26. Arezzo JC, Rosenstock J, Lamoreaux L, Pauer L. Efficacy and safety of pregabalin 600 mg/d for treating painful diabetic peripheral neuropathy: a double-blind placebo-controlled trial. BMC Neurol. 2008;8:33–45.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Satoh J, Yagihashi S, Baba M, Suzuki M, Arakawa A, Yoshiyama T, et al. Efficacy and safety of pregabalin for treating neuropathic pain associated with diabetic peripheral neuropathy: a 14 week, randomized, double-blind, placebo-controlled trial. Diabet Med. 2011;28:109–16.

    Article  CAS  PubMed  Google Scholar 

  28. Engelman E, Cateloy F. Efficacy and safety of perioperative pregabalin for post-operative pain: a meta-analysis of randomized-controlled trials. Acta Anaesthesiol Scand. 2011;55:927–43.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors are grateful to Prof. Hiroshi Nanjo (Department of Pathology, Akita University Graduate School of Medicine) and Prof. Akiteru Goto (Department of Cellular and Organ Pathology, Akita University Graduate School of Medicine) for suggesting pathological diagnoses. And we thank Prof. Katsuyuki Murata (Department of Environmental Health Sciences, Akita University Graduate School of Medicine) for suggesting statistics.

Conflict of interest

Yukako Imai and his co-authors have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Anaesthesia, Nakadori General Hospital, Akita, Japan

    Yukako Imai

  2. Department of General Thoracic Surgery (and Breast and Endocrine Surgery), Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan

    Kazuhiro Imai, Hajime Saito, Yusuke Sato, Satoru Motoyama & Yoshihiro Minamiya

  3. Department of Anaesthesia, Akita University Graduate School of Medicine, Akita, Japan

    Tetsu Kimura, Takashi Horiguchi, Toru Goyagi & Toshiaki Nishikawa

Authors
  1. Yukako Imai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kazuhiro Imai
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tetsu Kimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takashi Horiguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Toru Goyagi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hajime Saito
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yusuke Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Satoru Motoyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Toshiaki Nishikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yoshihiro Minamiya
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kazuhiro Imai.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Imai, Y., Imai, K., Kimura, T. et al. Evaluation of postoperative pregabalin for attenuation of postoperative shoulder pain after thoracotomy in patients with lung cancer, a preliminary result. Gen Thorac Cardiovasc Surg 63, 99–104 (2015). https://doi.org/10.1007/s11748-014-0466-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11748-014-0466-y

Keywords

Search

Navigation