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An epidural type catheter was placed in the pleural space under direct vision before the closure of the chest in 24 patients who underwent thoracotomy Jbr various types of lung or aortic surgery. All patients received intrapleural injections of 20 ml of 0.5 per cent bupivacaine with or without epinephrine as initial pain therapy. Patients also received subsequent doses of a similar volume of 0,375 per cent bupivacaine with epinephrine 1:200,000 up to four times a day for a maximum duration of seven days. Good pain relief was achieved in patients who underwent lateral and posterior thoracotomies. No pain relief was achieved in patients who underwent anterior thoracotomy or in patients in whom there was excessive bleeding in the pleural space. Bupivacaine blood concentrations were measured in I 1 patients following the initial dose 0.(20 ml of O.5 per cent bupivacaine (with epinephrine 1:200,000 in five of the 11 patients). The mean peak plasma concentration of bupivacaine when used with epinephrine was 0.32 +-0.02 I-~g' ml-I. The mean peak plasma concentrations of bupivacaine when used without epinephrine was 1.28 +-0.48 #g.m1-1, Our present data show that intrapleural analgesia is useful in the management of postoperative pain in patients who undergo thoracotomy. Our data also show that there is a significant decrease in peak plasma concentrations of bupivacaine when epinephrine is added to the solution (P < 0.05).

Avec le concours de candidats g~ une revascularisation coronarienne, nous avons mesurg l'effet de l'utilisation de bloqueurs des r~cepteurs histaminiques H t et 1-12 avant l' injection de protamine, sur la r~ponse hdmodynamique d cette derni&e. Les patients du Groupe 1 ne recevaient aucun pr~-traitement rnais nous injections prophylactiquement de la dyphenhydramine (anti-Hi) et de la cim~tidine (anti-H2) d ceux du Groupe H. Les moyennes des pressions art~rielles systoliques, diastoliques, des tensions veineuses centrales et du pouls avant (et aprds) r injection de protamine ~taient respectivement dans le 64 • 11 (51 • 8), 81 • 11 (65 • 10), 10 • 3 (11 + 7) mmHg et de 92 ++-10 (87 +-13) battements. min -t .Dans le Groupe 11, ces m~mes moyennes ~taient de: 113 +_ 19(113 + -17), 61 • 12(61 • 11), 79• 15(80• 13),9• 3 (9 + 2) mmHg et de 88 +-6 (86 +--4) Protamine, a highly alkaline compound, is used routinely to reverse the anticoagulation effect induced by heparin. Protamine administration is associated with adverse haemodynamic responses including acute anaphylaxis. I-3 Prophylactic treatment with histamine1 (H1) and hista-

Substance P, a neuropeptide associated with pain perception, is widely distributed in the central nervous system and is decreased in the cerebrospinal fluid of chronic pain patients as compared with that of healthy human volunteers. In this study, we have demonstrated the presence of immunoreactive substance P in saliva and further, that both saliva and plasma levels of immunoreactive substance P are lower in patients with chronic low back pain than in healthy human volunteers. To our knowledge, this is the first time that substance P has been identified in human saliva. These findings, together with the noninvasive nature of saliva collection, suggest that substance P in saliva may be useful as an alternative neurochemical correlate of chronic low back pain when collection of cerebrospinal fluid and plasma samples for substance P analysis is unacceptable or inappropriate.

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