Acetaminophen decreases early post-thoracotomy ipsilateral shoulder pain in patients with thoracic epidural analgesia: a double-blind placebo-controlled study.

OBJECTIVE: Despite effective epidural analgesia, up to 85% of post-thoracotomy patients complain of moderate-to-severe ipsilateral shoulder pain. This study assessed the efficacy of acetaminophen in decreasing postoperative shoulder pain after a thoracotomy. DESIGN: Double-blind randomized and placebo-controlled study. SETTING: University medical center. PARTICIPANTS: 65 patients. INTERVENTION: Patients were randomized into 2 groups; 31 patients received acetaminophen (group A), and 34 patients received a placebo (group P). After induction of anesthesia, patients received either a loading dose of acetaminophen, 1000 mg intrarectally, or a placebo suppository. Thereafter, acetaminophen, 650 mg, or a placebo, was administered intrarectally every 4 hours for 48 hours postoperatively. MEASUREMENTS AND MAIN RESULTS: Postoperative pain at the surgical site and shoulder pain were assessed separately every 4 hours for 48 hours using a numerical rating scale (NRS). Rescue analgesia for severe shoulder pain (NRS > 7) consisted of subcutaneous hydromorphone. Sixty-three patients experienced shoulder pain (97% prevalence). Demographic and intraoperative data were similar between the 2 groups. Average NRS for shoulder pain was higher in group P compared with group A at 8, 12, and 16 hours postoperatively (3.1 +/- 2.9, 2.6 +/- 2.6, 2.3 +/- 2.4 vs 1.8 +/- 2.6, 1.2 +/- 1.5, 1.3 +/- 1.8; P < 0.05). The total dose of hydromorphone did not differ between the 2 groups at 16, 24, and 48 hours. CONCLUSION: Acetaminophen decreases post-thoracotomy ipsilateral shoulder pain when given preemptively and regularly during the first 48 hours postoperatively in patients who received thoracic epidural analgesia.

A difficult airway is not more prevalent in patients suffering from spasmodic torticollis: a case series.

PURPOSE: We designed this retrospective study to assess the frequency of difficult airway and difficult intubation in patients with spasmodic torticollis and compare it to that of the general population. METHODS: After Institutional Review Board approval, data were collected from the charts of all the patients with spasmodic torticollis who underwent selective peripheral denervation at our institution between 1988 and 2001. The intubation grade was determined using the Cormack and Lehane laryngoscopic classification. The best laryngeal view was recorded. RESULTS: Data from 342 patients were available for analysis. Fourteen patients had a difficult airway. In two patients, intubation was difficult with three attempts at laryngoscopy in one patient and use of fibreoptic bronchoscopy in the other. Twelve (3.5%) patients presented with laryngoscopic grades of III or IV. The combined prevalence of laryngoscopic view grade III and IV and difficult intubation was 4.4%. CONCLUSIONS: This study assesses the frequency of difficult intubation in patients suffering from spasmodic torticollis. When compared to the general population, these patients do not appear to have a higher frequency of difficult airway or difficult intubation.