Interpleural Administration of Bupivacaine after Cholecystectomy: A Comparison with Intercostal Nerve Block

Abstract

Pethidine requirements and verbal pain scores were recorded in 36 patients after cholecystectomy via subcostal incision. All patients also received 20 ml 0.5% bupivacaine with adrenaline 11200,000. Group 1 (12 patients) received unilateral intercostal nerve blocks. Interpleural catheters were inserted through the 8th intercostal space in the remaining patients; 12 received local anaesthetic via the catheter immediately after surgery (Group 2) and 12 were given local anaesthetic at three hours (Group 3). Small asymptomatic pneumothoraces were noted on chest X-ray in six of the 24 patients with interpleural catheters. Both types of local anaesthesia produced lower pain scores than pethidine alone (P < 0.05) with 25% of intercostal nerve blocks and 63% of interpleural catheters requiring no pethidine in the following three hours. The provision of catheter 'top-ups' between six and 18 hours after surgery also resulted in lower pain scores and a reduction in pethidine requirements (P < 0.05).

Interpleural analgesia for attenuation of postoperative pain after hepatic resection*

“…A continuous infusion of levo‐bupivacaine was commenced at 12.5 mg.h −1 . Patients therefore received levo‐bupivacaine 300 mg per day (excluding initial loading dose), a 24‐h dose range that has been shown to be effective in other studies [1, 9, 18].…”

“…Derangements in coagulation after hepatic resection have favoured systemic multimodal analgesia in preference to neuraxial techniques as the preferred method for effective delivery of postoperative analgesia in many institutions. Several studies report the use of interpleural local anaesthetic solutions as an effective technique for analgesia following unilateral upper abdominal surgery [1–19]; however, it is unknown if interpleural analgesia is effective for patients receiving a right subcostal surgical incision with a midline abdominal incision extension (reverse‐L incision), a commonly used surgical incision for patients undergoing this procedure. For patients undergoing hepatic resection we think that interpleural analgesia is a beneficial analgesic adjunct to systemic morphine patient controlled analgesia.…”

A comparative study of efficacy of epidural versus interpleural bupivacaine for post operative analgesia after open cholecystectomy

“…5 Different centers have tried different techniques and drugs for effective pain relief after cholecystectomies, the intercostal nerve blocks, thoracic extradural opioids or local anesthetics, interpleural injection of local anesthetics, local wound infiltration, different parenteral and oral drugs. 6,7 Extradural blockade with local anesthetic agents provides excellent analgesia in comparison to extradural opiates. This technique is relatively free from side effects like respiratory depression, pruritis, and urinary retention.…”