Surgical position and ipsilateral shoulder pain after thoracic surgery

Abstract

This study retrospectively examined post-operative ipsilateral shoulder pain in patients after thoracic surgery. The study included 205 patients who underwent thoracic surgery in a lateral position from January 1, 2017 to November 30, 2017. Minors and re-operation cases were excluded. Complete video-assisted thoracic surgery (VATS) was performed for 60 patients and mini-thoracotomy for 145 patients. Among the 136 male and 69 female patients, the median age was 71 years. Under complete VATS, the upper extremity on the operative side was fixed in an adducted and medially rotated position parallel to the opposite upper extremity. In mini-thoracotomy cases, the upper extremity on the operative side was fixed in an abducted and medially rotated position. In univariate analysis, there was no significant difference in age, sex, operative time, or bleeding between the groups with and without shoulder pain. Post-operative shoulder pain was significantly weaker in patients who underwent complete VATS and higher in those who underwent lobectomy or more extensive resection. In multivariate analysis, only complete VATS was an independent predictive factor. Only one of the 60 patients who underwent complete VATS complained of mild shoulder pain. Adduction and medial rotation of the upper extremity on the operative side during surgery is thought to be useful in preventing postoperative shoulder pain.