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The Development of the Arm Fixation Method to Prevent Ipsilateral Shoulder Pain in Patients Undergoing Lung Resection

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Abstract

Purpose

The aim of the present study was to investigate the efficacy of a new upper limb fixation method—body pillow position for preventing postoperative ipsilateral shoulder pain (ISP) in patients undergoing lung resection.

Design

An experimental study design was used.

Methods

We conducted two comparisons (group A: the previous position using the arm fixation device; group B: the body pillow position) at random and examined an arm fixation method that is effective for ISP prophylaxis in patients undergoing surgery in the lateral decubitus position.

Findings

We approached 87 patients, two were excluded, and, thus, 85 were randomly assigned to group A (n = 43) or group B (n = 42). No significant differences were observed in the frequency of ISP between groups A and B (25.6% vs 26.2%). The intensity of ISP between both groups was analyzed by a repeated-measures analysis of variance and was shown to decrease over time in 22 patients (P = .010). The intensity of ISP on postoperative days 0 to 3 was slightly lower in group B than in group A (P = .158). Risk factors for ISP were the duration of surgery (odds ratio, 1.01; 95% confidence interval, 1.00 to 1.01) and pre-existing shoulder stiffness (odds ratio, 5.15; 95% confidence interval, 1.07 to 24.83).

Conclusions

There was no significance in the frequency of ISP between group A and group B. The intensity of ISP on postoperative days 0 to 3 was lower in group B than in group A, although there was no significant difference. It is important perspective for perioperative care providers to prevent ISP for early postoperative recovery and improvement of postoperative quality of life. These results suggested that we must consider a better position for preventing postoperative ISP in patients undergoing lung resection.

Section snippets

Background

Patients who have undergone thoracic surgery often develop ISP, and its incidence has ranged between 31% and 75% depending on the surgical procedure, surgical approach, patient positioning, and duration of surgery.4, 5, 6, 7, 8 The intensity of ISP is scored between 3 and 9 on a 10-point numerical rating scale (NRS) or a visual analog scale and continues for 3 to 4 days after surgery.5,7, 8, 9 In our previous study, we used the arm fixation method of Figure 1A in the decubitus position and

Methods

At the time of surgery, various positions are set mainly for the purpose of facilitating the operation, but it is most important to ensure the safety of the patient.19 To perform lung resection, the patient has to be placed in a lateral decubitus position because of the anatomic position of the lung.14 When surgery is performed in the lateral decubitus position, it is necessary to fix the arm on the side of the surgery so that it does not fall off. A typical conventional arm fixation method is

Patient Characteristics

The enrollment algorithm for the arm fixation method is shown in Figure 2. Of 87 patients, two were excluded because their BMI was higher than 30. Therefore, 85 patients were randomly assigned to the traditional position using the arm fixation device (group A, n = 43) or body pillow position (group B, n = 42). All patients in each group were followed up and analyzed.

A summary of the sociodemographic and clinical characteristics of groups A and B is shown in Table 1. The median ages of groups A

Discussion

Because of advances in surgical and anesthetic techniques and instruments in recent years, VATS is regarded as a minimally invasive surgery. The advantages of VATS are a small skin incision, less postoperative pain,6,22 shorter hospital stays,22,23 and improved patient satisfaction.22 Although the pain associated with skin incisions has been reduced by the minimal invasiveness of the VATS procedure, the incidence of ISP caused by the decubitus position remains between 31% and 75%.4, 5, 6, 7, 8

Conclusions

Although advances in anesthesia and surgical techniques have greatly contributed to the early recovery of postoperative patients, there are patients who complain of ISP of unknown origin after surgery. The emergence of ISP may reduce the QOL of patients after surgery, even if pain from surgical wounds is managed successfully. The prevention of ISP by using a better perioperative posture fixation method without prophylactic medication will be advantageous for patients. Therefore, it is

Acknowledgments

The authors thank the patients and health care professionals who cooperated with this study. They also thank Yoshihiro Okayama of Tokushima University for guidance on statistical methods and the reliability of the results.

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    © 2020 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.