Sphenopalatine ganglion block for ipsilateral shoulder pain following open pancreaticoduodenectomy

A 59-year-old woman underwent an open pancreaticoduodenectomy. Thoracic patient controlled-epidural anaesthesia provided excellent incisional pain relief; however, the patient experienced intractable left shoulder pain (10/10 on the Numerical Rating Scale). To our knowledge, there is no effective es...

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Bibliographic Details
Published in:	BMJ case reports Vol. 15; no. 1; p. e243746
Main Authors:	Levin, Danielle, Acquadro, Martin, Cerasuolo, Joseph, Gerges, Frederic
Format:	Journal Article
Language:	English
Published:	England BMJ Publishing Group LTD 06-01-2022 BMJ Publishing Group
Subjects:	Acetaminophen - therapeutic use Analgesics Anesthesia Anti-inflammatory agents Case Report Case reports Cotton Epidural Female Humans Lidocaine Middle Aged Narcotics Neck pain Pain, Postoperative - drug therapy Pancreas Pancreaticoduodenectomy Patients Shoulder Shoulder Pain - drug therapy Shoulder Pain - etiology Sphenopalatine Ganglion Block Surgery Surgical anastomosis gastrointestinal surgery pain
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Summary:	A 59-year-old woman underwent an open pancreaticoduodenectomy. Thoracic patient controlled-epidural anaesthesia provided excellent incisional pain relief; however, the patient experienced intractable left shoulder pain (10/10 on the Numerical Rating Scale). To our knowledge, there is no effective established treatment for patients experiencing shoulder pain after an open pancreaticoduodenectomy. The patient's shoulder pain did not respond to medical management with acetaminophen, ketorolac, lidocaine transdermal patch, oxycodone and hydromorphone. Then, on postoperative day 2, the acute pain service was consulted. Considering that the sphenopalatine ganglion block has been previously reported to be helpful in a number of painful conditions, including shoulder tip pain after thoracic surgery, we offered this treatment to the patient. After just one topical sphenopalatine ganglion block, using a cotton-tipped applicator, the patient's shoulder pain entirely resolved and did not return. This is the first report of a successful treatment of intractable ipsilateral shoulder pain following an open pancreaticoduodenectomy with transnasal sphenopalatine ganglion block.
Bibliography:	ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3
ISSN:	1757-790X 1757-790X
DOI:	10.1136/bcr-2021-243746