ESRA Academy. Venkatachalam S. Sep 8, 2016; 138603; 0484 Topic: PAIN THERAPY (ACUTE - CHRONIC)
Dr. Shakthi Jayanthy Venkatachalam
Dr. Shakthi Jayanthy Venkatachalam

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Background and Aims:

Anecdotal opinion suggests shoulder pain post-oesophagectomy surgery can be severe and have a significant effect on patient recovery including pain related physiological changes, delayed healing and difficulty complying with physiotherapy; especially on the first post-operative day. Our study aimed at looking into the incidence of shoulder pain on the first post-operative day, rescue analgesia provided and the patient’s response to different analgesic modes used for treating the shoulder pain.


The following data were collected retrospectively from patient`s anaesthetic charts, post-operative notes and observation charts of 28 patients who underwent surgery.

  1. Patient demographics (Age, Sex, ASA Grade, presence or absence of chronic pain)
  2. Type of surgery (minimally invasive oesophagectomy; thoraco-abdominal approach; laparoscopy with thoracotomy)
  3. Post-operative analgesia planned (epidural versus PCA)
  4. Presence or absence of shoulder pain and pain scores
  5. Rescue analgesia offered (opioids versus non-opioids)
  6. Pain scores post rescue analgesia.

Out of 22 patients included in the study, 13 patients had significant shoulder pain; 6 patients did not complain of pain; 3 patients had inadequate documentation. Their average pain score was 6.1 and 1.4 post rescue analgesia. We noted that all patients responded poorly to non-opioid analgesics and had significant pain relief with opioids.


We concluded from our observations that opioids were the only analgesics which provided satisfactory shoulder pain relief. It was recommended to our recovery nurses and acute pain team to have a low threshold for opioids in patients complaining of shoulder pain. The future plan is to repeat the study in a year's time.

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