Interpleural Analgesia Does Not Influence Postthoracotomy Pain

Silomon, M.; Claus, Thorsten; Huwer, Hanno; Biedler, A.; Larsen, Reinhard; Molter, G.

doi:10.1097/00000539-200007000-00009

Cited by 18 publications

(14 citation statements)

References 16 publications

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“…In contrast, several studies have shown limited efficacy of this analgesic method. [15][16][17] Elman and colleagues 15 found insufficient pain relief with interpleural bupivacaine after posterolateral thoracotomy, despite high plasma bupivacaine levels. Negative results may be related to loss of anesthetic through thoracic tubes, dilution of local anesthetic by pleural blood and secretions, altered diffusion across the parietal pleura because of surgical manipulation and inflammation, and failure to clamp the chest tube before administration of anesthetic.…”

Section: Discussionmentioning

confidence: 99%

Interpleural Morphine vs Bupivacaine for Postthoracotomy Pain Relief

Dabir

Parsa

Radpay

et al. 2008

Asian Cardiovasc Thorac Ann

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This prospective randomized double-blind trial was designed to compare the analgesic effects of interpleural bupivacaine and interpleural morphine for postthoracotomy pain management. Thirty-six American Society of Anesthesiologists class I and II patients undergoing an elective posterolateral thoracotomy were randomly divided into 2 groups of 18 each. Before chest closure, an interpleural catheter was inserted under direct vision. At the end of the operation and every 4 hours thereafter, they received either 0.25% bupivacaine with epinephrine or 0.2 mg x kg(-1) morphine sulfate interpleurally for 24 hours. The chest tubes were clamped during injection and for 15 min afterwards. Supplementary doses of intravenous morphine were given on request. The pain severity was evaluated at rest and on coughing before and 30 min after each interpleural injection, using an 11-point visual analog scale. Supplemental analgesic consumption and side effects were recorded. Both interpleural morphine and bupivacaine significantly reduced pain scores 30 min after each injection. However, pain scores and supplementary analgesic requirements were significantly lower in the interpleural morphine group. No serious side effects were detected in either group. Interpleural morphine provides better pain control than interpleural bupivacaine after a posterolateral thoracotomy.

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Section: Discussionmentioning

confidence: 99%

Interpleural Morphine vs Bupivacaine for Postthoracotomy Pain Relief

Dabir

Parsa

Radpay

et al. 2008

Asian Cardiovasc Thorac Ann

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“…Several studies have shown limited improvement in analgesia with IP [12,17,18]. Explanations for the limited analgesic efficacy of IP include loss of local anesthetic through the chest tube, dilution of local anesthetic with blood and exudative fluid present in the pleural cavity, binding of local anesthetic with proteins, and altered diffusion across the parietal pleural after surgical manipulation and inflammation [18,19].…”

Section: Discussionmentioning

confidence: 99%

Interpleural versus epidural analgesia with ropivacaine for postthoracotomy pain and respiratory function

Yıldırım

Akay

Bingöl

et al. 2007

Journal of Clinical Anesthesia

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“…M-S is generally less painful than thoracotomy and pain control by epidural catheter infusion is easy. Lateral thoracotomy is more painful and pain control is difficult, and limits breathing, which may result in postoperative lung complications such as pneumonia and atelectasis [1,10,12]. With regard to pain control, Goncalves et al [11] recommended M-S as the procedure of choice in childhood when excising bilateral pulmonary metastases because they found that patients who had a lateral thoracotomy had more pain after surgery (more complaints were registered and more analgesic drugs were used); in fact some children had difficulty in raising the ipsilateral arm due to pain.…”

Section: Discussionmentioning

confidence: 99%

Median sternotomy provides excellent exposure for excising anterior mediastinal tumors in children

et al. 2005

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Median sternotomy (M-S) provides excellent exposure and allows dissection of the medial side of an anterior mediastinal tumor (AMT) with minimal risk. We report our experience of resecting AMT using M-S. Five children with AMT were treated using M-S between 1997 and 2004 at our institute. Ages at M-S ranged from 8 months (case 2) to 9 years (case 1) and AMT ranged in size from 5x6x7 cm3 (case 2) to large enough to occupy nearly the entire right thoracic cavity (cases 4 and 5). AMT were resected completely in all cases through M-S with the patient in the supine position. M-S alone was used in cases 1, 2, and 3, and cases 4 and 5 required additional incisions. There were dense adhesions between AMT and important mediastinal structures such as the anterior part of the pericardium (cases 1 and 2), left phrenic nerve (case 3), and pulmonary vessels (case 4, 5), but all were dissected safely under direct vision. There was no respiratory or cardiovascular compromise during M-S due to compression of the healthy lung and mediastinum. Histopathologic findings were mature teratoma in cases 1, 3, and 5, immature teratoma in case 2, and pleuropulmonary blastoma in case 4. Postoperative recovery was unremarkable. After mean follow-up of 3.4 years, cases 1, 2, 3, and 5 are currently well with no signs of recurrence, but case 4 died from disseminated intravascular coagulation during postoperative chemotherapy for massive local tumor recurrence 6 months after surgery. Based on our experience, M-S allows access to all aspects of AMT under direct vision, and provides excellent exposure, thus facilitating complete resection.

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Interpleural Analgesia Does Not Influence Postthoracotomy Pain

Abstract: The efficacy of interpleural analgesia to reduce postoperative pain intensity in patients after lateral thoracotomy is controversial. In this study, we demonstrated a lack of efficacy of interpleural analgesia.

Cited by 18 publications

References 16 publications

Interpleural Morphine vs Bupivacaine for Postthoracotomy Pain Relief

Interpleural Morphine vs Bupivacaine for Postthoracotomy Pain Relief

Interpleural versus epidural analgesia with ropivacaine for postthoracotomy pain and respiratory function

Median sternotomy provides excellent exposure for excising anterior mediastinal tumors in children

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