<b>開胸術後の同側頸肩部疼痛に対するトリガーポイント注射の有用性 </b>

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  • <b>Effects of trigger-point injection on shoulder pain </b><b>after thoracotomy </b>

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   Despite receiving postoperative thoracic epidural analgesia, severe shoulder pain on the ipsilateral side is common in patients after thoracotomy. The pain is relatively resistant to IV opioids or moderate doses of non steroidal antiinflammatory drugs, and increasing doses of the epidural analgesic to achieve adequate analgesia may result in unacceptable levels of sedation and hypotension. Effective analgesia for postthoracotomy shoulder pain has been achieved by infiltrating local anesthetics around the phrenic nerve, however, there is a potential problem of diaphragmatic dysfunction and the associated risk of respiratory depression. We investigated whether trigger-point injection with lidocaine would treat postthoracotomy shoulder pain effectively.<br>   Methods: Trigger-point injection with lidocaine was performed in 11 patients who complained shoulder pain after the thoracotomy surgery. All patients received general anesthesia combined with a midthoracic epidural anesthesia. Eleven patients complained shoulder pain after thoracotomy surgery, and all of them had trigger-points in the ipsilateral suprascapular regions with severe pain. After disinfecting the skin at the two or three most painful trigger-points, 1% lidocaine were injected IM into one side of the trapezius muscle by using a 25-gauge needle. Shoulder pain was assessed before and immediately after the injection, using a 10-point verbal ranking score (VRS), and VRS before the injection point were considered as 10. Data were expressed as mean ± SD.<br>   Results: There were significant (p<0.05) decreases in VRS after the injection. VRS score were 4.6 ± 3.1 immediately after the injection, showing significantly less (p<0.05) pain after the injection.<br>   Conclusions: This result suggests that this pain observed is likely a sort of myofascial pain syndrome due to possible intraoperative positioning. Trigger-point injection is an effective and safe alternative to relief of ipsilateral shoulder pain after thoracotomy.

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  • PAIN RESEARCH

    PAIN RESEARCH 18 (2), 67-70, 2003

    日本疼痛学会

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