What causes pain in the shoulder, neck, and ear following a lung lobectomy (lobectomy removal of a lung lobe)?

From the Guidelines

Pain in the shoulder, neck, and ear following a lobectomy can be effectively managed with a multimodal approach, including postoperative locoregional analgesia techniques, such as continuous paravertebral block, and multimodal physiotherapy, as recommended by the most recent guidelines 1. The pain experienced after a lobectomy is likely related to post-thoracotomy pain syndrome or nerve irritation, and can be addressed with a combination of pharmacological and non-pharmacological interventions.

• The use of postoperative locoregional analgesia techniques, such as continuous paravertebral block, is recommended as a first-line treatment for post-thoracotomy pain syndrome, due to its better safety profile compared to thoracic epidural analgesia 1.
• Multimodal physiotherapy, including early mobilisation, breathing exercises, and bronchial drainage and coughing techniques, is also recommended as part of the postoperative management, as it has been shown to reduce the postoperative pulmonary complication rate and improve patient outcomes 1.
• The addition of other techniques, such as incentive spirometry or vibratory expiratory pressure, to this set of measures may be considered on a case-by-case basis, but should not be applied alone.
• Pharmacological interventions, such as acetaminophen and NSAIDs, can also be used to manage pain, but should be used in conjunction with other modalities, as part of a multimodal approach.
• It is essential to note that the management of post-lobectomy pain should be individualised, taking into account the patient's specific needs and medical history, and that a multidisciplinary approach, involving surgeons, anaesthetists, physiotherapists, and other healthcare professionals, is crucial to achieving optimal outcomes.

From the Research

Pain in Shoulder, Neck, and Ear after Lobectomy

• The provided studies do not directly address pain in the shoulder, neck, and ear after lobectomy. However, some studies discuss postoperative pain management and neuropathic pain, which may be relevant to understanding the potential causes of pain in these areas.
• A study on multimodal analgesic treatment in video-assisted thoracic surgery lobectomy found that a combination of paracetamol, non-steroidal anti-inflammatory drug, and gabapentin, along with a single-shot paravertebral block and an intraoperative intercostal catheter, can effectively manage postoperative pain 2.
• Another study examined the effect of preoperative gabapentin and acetaminophen on opioid consumption in video-assisted thoracoscopic surgery and found that it can reduce the incidence of high-dose postoperative opioid consumption 3.
• A case report discussed the use of lacosamide as an alternative treatment for post-surgery neuropathic pain in a patient allergic to gabapentin and pregabalin, highlighting the importance of considering alternative treatments for neuropathic pain 4.
• A study on trigeminal neuropathic pain as a complication of anterior temporal lobectomy reported two cases of neuropathic pain following temporal lobe resections, which may be relevant to understanding the potential causes of pain in the face and ear area 5.
• A review article on the diagnosis and management of shoulder pain discussed the importance of correlating clinical assessment with imaging signs and using ultrasound-guided injection and other techniques to treat shoulder pain, which may be relevant to managing pain in the shoulder area 6.