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Modified lateral positioning. This will ensure less pressure and stretch on shoulder than standard lateral positioning.

Right before surgery, the patient are posistioned in lateral position with arm elevated (not more than 90 degree from torso). In the intervention, the arm will be lowered and placed in towards the torso for patients enrolled in the experimantal arm.

Modified lateral positioning.

Stein O Danielsen

Up to 85% experience shoulder pain after thoracic surgery, especially on the same side as surgery are performed. Referred phrenic nerve pain is probably one cause of ipsilateral shoulder pain (ISP), and positioning of the arm during surgery another. Studies indicates that ISP can be caused by the positioning of the patient during surgery due to muscle -and ligament strain. Can a change in the surgical positioning (less press and stretch) of the ipsilateral arm effect the shoulder pain after thoracic surgery?

Surgical Positioning of the Arm During Thoracic Surgery -Effect on Shoulder Pain After Surgery?

Lateral Surgical Positioning for Thoracic Surgery -Effect on Ipsilateral Shoulder Pain?

Using visual analog scale for assesing pain in the shoulder (Scale from 0-10). Mesauring times: VAS pain related to the shoulder before surgery, VAS pain shoulder at day 1 and 3 after surgery. Further will Oslo University Hospital scheme for registration of pain for location and characteristic also be used.

All extra pain medication patient use after surgery until day 4, type and dose, will be mesaured.

Mesaured before surgery, and at day 1 and 3 after surgery.

Measured before surgery, and at day 1 and 3 after surgery.

Oslo University Hospital

RN, MNSc

Skin and Connective Tissue Diseases

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Anti-Arrhythmia Agents

Channel Blockers

Central Nervous System Depressants

All Drugs and Chemicals

Lidocaine

Anesthetics

Anesthetics, Local

Sodium Channel Blockers

Diuretics, Potassium Sparing

Patients who are undergoing a thoracotomy will be informed that they may develop moderate to severe postoperative ISP and may have the option to receive an SPG block. The SPG block will be performed every three minutes for 20 minutes, 0.1mL of the 4% lidocaine will be administered through. After 20 minutes and various intervals thereafter the patient will be asked to rate their shoulder pain.

Sphenopalatine Ganglion (SPG) Block

lidocaine

Gilbert Grant, MD

The purpose of this pilot study is to evaluate the utility of sphenopalatine ganglion (SPG) block to manage ipsilateral shoulder pain (ISP) after thoracotomy. This will be an open label preliminary pilot study to determine if SPG block has potential utility to manage ISP in post-thoracotomy patients. The primary outcome variable will be reduction of shoulder pain.

This is an open label preliminary pilot study which will evaluate the utility of sphenopalatine ganglion (SPG) block to manage ipsilateral shoulder pain (ISP). It will determine if SPG block has potential utility to manage ISP in post-thoracotomy patients One hundred (100) patients will initially be consented in this study. Patients have to develop ISP and have a pain VAS \>= 5. The study is seeking ten (10) eligible participants.

Patients will be followed after the SPG block(s), and the duration of pain relief will be monitored by serial assessments of the VAS. This assessment will occur for the initial SPG block and for all follow-up blocks, if performed. The follow-up assessments will only involve having the patient rate the ISP using a verbal VAS; This will take less than a minute of patients time. In addition, all patients will have PRN access to standard systemic analgesics as routinely ordered by the surgical service Safety assessments will be performed on all subjects. Blood pressure, heart rate and respiratory rate will be obtained every 15 minutes after each SPG block for 90 minutes. Dr. Grant will monitor the subjects for 90 minutes after each SPG block.

Sphenopalatine Ganglion Block to Treat Shoulder Pain After Thoracotomy

Sphenopalatine Ganglion Block to Treat Shoulder Pain After Thoracotomy- An Open Label Pilot Study

Patients will be followed after the SPG block(s) and the duration of pain relief will be monitored by serial assessments of the VAS. This assessment will occur for the initial SPG block and for all follow-up blocks, if performed.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Surgical Positioning of the Arm During Thoracic Surgery -Effect on Shoulder Pain After Surgery?	NCT02149849	Lung Cancer	Modified latera...	18 Years -	Oslo University Hospital
Surgical Positioning of the Arm During Thoracic Surgery -Effect on Shoulder Pain After Surgery?	NCT02149849	Lung Cancer	Modified latera...	18 Years -	Oslo University Hospital
Sphenopalatine Ganglion Block to Treat Shoulder Pain After Thoracotomy	NCT02733393	Ipsilateral Sho...	Sphenopalatine ... lidocaine	18 Years -	NYU Langone Health

Spots Global Cancer Trial Database for ipsilateral shoulder pain