Interpleural or thoracic epidural analgesia for pain after thoracotomy. A double blind study

Abstract

The analgetic effect of bupivacaine given epidurally or interpleurally after thoracotomy was investigated in a randomized, double blind, placebo controlled study. 32 patients with both an epidural and an interpleural catheter, were randomized to receive either interpleural or epidural analgesia. The interpleural group was given bupivacaine 5 mg.ml-1 with 5 microgram epinephrine as a 30 ml interpleural bolus, followed by a continuous infusion starting at a rate of 7 ml per hour and epidurally a bolus of 0.9% NaCl followed by a continuous infusion of 0.9% NaCl. The epidural group was given bupivacaine 3.75 mg.ml-1 with 5 microgram epinephrine as a 5 ml epidural bolus, followed by a continuous infusion starting at a rate of 5 ml per hour and interpleurally a bolus of 0.9% NaCl followed by a continuous infusion of 0.9% NaCl. The draining tubes were clamped during the injection of the interpleural bolus and 15 min afterwards. Adequacy of pain relief was evaluated with the Prins-Henry pain scale. Morphine requirement was registered, there was no difference between the groups in pain scores or need for additional morphine.

A prospective, randomized comparison of interpleural and paravertebral analgesia in thoracic surgery

“…In many studies patients are kept supine for up to 20 min after a bolus to facilitate diffusion of local anaesthetic through the parietal pleura into the intercostal nerves [10][11][12][13][14][15]. We used a postoperative continuous infusion regimen, which has been recommended in the interests of efficacy [13,[15][16][17], but which would require a continuous supine posture for optimum analgesic effect.…”

Postoperative Pain and Other Acute Pain Syndromes

“…Interpleural blocks may or may not be as effective as epidural blocks in patients who have rib fractures 470,471 or have undergone thoracotomy. 472,473 Because insertion may be technically difficult, catheters may be misplaced into either the pleura or the chest wall. Pneumothorax is the most common complication of interpleural catheters.…”

Postoperative Pain and Other Acute Pain Syndromes

“…305 Interpleural blocks may or may not be as effective as epidural blocks in the setting of rib fractures, 306,307 or after thoracotomy. 308,309 Catheter insertion may be technically diffi cult and can result in catheter misplacement either into the pleura or the chest wall. Pneumothorax is the most common complication of interpleural catheters.…”