Interpleural block – part 2

Abstract

SummaryInterpleural blockade is effective in treating unilateral surgical and non-surgical pain from the chest and upper abdomen in both the acute and chronic settings. It has been shown to provide safe, highquality analgesia after cholecystectomy, thoracotomy, renal and breast surgery, and for certain invasive radiological procedures of the renal and hepatobiliary systems. It has also been used successfully in the treatment of pain from multiple rib fractures, herpes zoster, complex regional pain syndromes, thoracic and abdominal cancer, and pancreatitis. The technique is simple to learn and has both few contra-indications and a low incidence of complications. In the second of two reviews, the authors cover the applications, complications, contra-indications and areas for future research. The interpleural route for the administration of local anaesthetic agents is capable of providing effective analgesia for postoperative, acute and chronic pain originating within the distribution of intercostal nerves. Local anaesthetic solutions can be administered as single or intermittent boluses, or as continuous infusions via an interpleural catheter. It has been shown to provide safe, high quality analgesia after cholecystectomy, thoracotomy, renal surgery and breast surgery, and for some invasive radiological procedures of the renal and hepatobiliary system. It has also been used successfully in the treatment of pain from multiple rib fractures, herpes zoster, Complex Regional Pain Syndromes (CRPS), thoracic cancer, abdominal cancer and pancreatitis. The first part of this review focused on the history, anatomy, mechanism of action, technique and local anaesthetic dosage regimens for this block. In the second part, we consider the applications, complications, contra-indications and areas for future research. Indications for interpleural block

An Evidence-Based Review of the Efficacy of Perioperative Analgesic Techniques for Breast Cancer-Related Surgery

“…Local anesthetic is deposited between the parietal and visceral pleura [158][159][160], where it then diffuses to the subpleural space and the intercostal nerves [159][160][161]. In one RCT comparing single-injection interpleural and single-level paravertebral blocks (both bupivacaine 0.5%) for patients undergoing mastectomy, pain scores and analgesic consumption were similar for both interventions [161].…”

“…Both treatment groups also exhibited decreased lung functions on the first postoperative day, which improved to near-normal levels by the second postoperative day. Risks of this procedure include pneumothorax, intravascular injection, and intra-bronchial infection [159,160]. Similar to the Pecs blocks, there is extremely little data involving interpleural blocks on which to base recommendations regarding breast surgery anesthesia and analgesia.…”

Intrapleural Analgesia Using Ropivacaine for Postoperative Pain Relief after Minimally Invasive Thoracoscopic Surgery

“…14) Pneumothorax may occur because of air entrainment or as a result of damage to the lung parenchyma caused by the percutaneous technique of catheter placement. 15) Placement under direct vision such as our technique clearly reduces the incidence of pneumothorax.…”

Interpleural blocks and clotting abnormalities: a case report

“…We thank Drs Al-Naimi, Hussain and Pennefather for their interest in our article [1,2] and are grateful for their comments. Their experience [3] reinforces the limitations discussed in our review that this block would be of no benefit where the pleural cavity has blood, exudates or air.…”

“…It would be interesting to see if an interpleural catheter kept in the upper pleural cavity at the end of surgery, or a period of Trendelenberg positioning after administering the local anaesthetic could be usefully utilised for controlling shoulder pain. We read with interest the recent review articles concerning interpleural blocks [1,2]. In particular we noted the suggestion that interpleural blocks may have an important role for patients with clotting abnormalities.…”