In select patients, ipsilateral post-thoracotomy shoulder pain relieved by suprascapular nerve block.

Shoulder pain following thoracotomy is a common postoperative complaint and can be difficult to treat. This article explores how to select patients who would benefit from a suprascapular nerve block for post-thoracotomy shoulder pain. A retrospective case review of 178 patients who underwent thoracotomy at our institution was performed. Only patients with elicitable local signs of musculoskeletal shoulder pain were offered a suprascapular nerve block with 10 cc of 0.25% bupivicaine. Of 178 patients, 92 (51.7%) complained of post-thoracotomy shoulder pain. Of these patients, 34 (37.0%) had localizing signs of musculoskeletal shoulder pain and underwent suprascapular nerve block. Twenty-nine of 34 (85.3%) patients obtained satisfactory pain relief. We estimate a true-positive rate of 85.3% with a 95% confidence interval of (68.9%, 95.0%) for those patients who received relief from suprascapular nerve block after localizing signs on physical examination of the shoulder. Patients post-thoracotomy with local signs of shoulder pain on physical examination may benefit from suprascapular nerve blocks in the immediate postoperative period.

Spinal cord stimulation for the treatment of chronic knee pain following total knee replacement.

BACKGROUND: Chronic pain after total knee replacement is common but remains poorly understood. Management options for patients with this condition are traditionally limited to pharmacological approaches. OBJECTIVE: This article presents a case of using spinal cord stimulation in the management of chronic knee pain following total knee replacement. DESIGN: Case report. SETTING: Pain management clinic METHODS: A 68-year old patient presented with a 3-year history of persistent knee pain following total knee replacement. After failing to respond to medications and nerve blocks, a trial of spinal cord stimulation and subsequent permanent implantation of a spinal cord stimulator (SCS) were performed. The Oxford knee score (OKS) was used to assess her pain and functionality before and after SCS implantation. RESULTS: The patient reported improvement in her pain and function. Her baseline OKS was 39 and fell to 26 one year post implantation of an SCS representing a reduction of pain and disability from severe to moderate. LIMITATIONS: A case report. CONCLUSION: Spinal cord stimulation might be an option in the management of refractory knee pain following total knee replacement.