Ipsilateral shoulder pain in patients following lung resection in the decubitus position

Aim and objective: The purpose of this study was to examine the frequency, influencing factors, and clinical course of shoulder pain in patients following lung resection.
Background: Thoracoscopes have been introduced in the surgical treatment of lung cancer, and allow for less invasive surgery with a minimal incision. However, decubitus position-related shoulder pain on the operated side has not yet been investigated.
Design: A longitudinal descriptive study.
Methods: Patients who underwent lung resection in the decubitus position. Patients were interviewed 2 days before surgery and once daily for 5 days after surgery. Interview items included background data, the concomitant use of epidural anesthesia, operative duration, presence of preoperative shoulder stiffness (excluding shoulder pain), type of surgery, and site of operation. The intensity of pain was approximately 5 on an 11-point numerical rating scale. Descriptive statistics on patient backgrounds were obtained using SPSS Statistics 22 for Windows.
Results: Of the 74 patients who underwent lung resection in a decubitus position, 30(40.5%) developed shoulder pain on the operated side. The highest rating occurred 1 day after surgery and decreased over time. The following two factors were found to influence shoulder pain on the operated side: operative duration(Z=-2·63;p=0·01), and presence of preoperative shoulder stiffness(excluding shoulder pain)(χ2＝4·16;p=0·04).
Conclusions: This study demonstrated that approximately 40% of patients who underwent lung resection in the decubitus position developed shoulder pain.
Relevance to clinical practice: The presence of postoperative shoulder pain was related to both the duration of the operation and to the presence of preoperative shoulder stiffness. Although the shoulder pain resolves within 4 days, it causes the patient additional discomfort and distress. Therefore, further research is needed on positioning for thoracotomy in order to investigate ways to reduce or eliminate this complication of lung surgery.

This is the peer reviewed version of the following article: Bando, T, Kondo, K, Onishi, C, et al. Ipsilateral shoulder pain in patients following lung resection in the decubitus position. J Clin Nurs. 2018; 27: 1192– 1197., which has been published in final form at https://doi.org/10.1111/jocn.14163. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.