Intrapleural Analgesia for Postthoracotomy Pain and Blood Levels of Bupivacaine Following Intrapleural Injection

Kambam, J. R.; Hammon, John W.; Parris, Winston C. V.; Lupinetti, Flavian M.

doi:10.1097/00132586-198912000-00037

Cited by 13 publications

(20 citation statements)

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“…Although intrapleural injections are "normally" gravity dependent (70), in the case of a thoracotomy (with elimination of the negative pressure and an ipsilateral reduction in functional residual capacity (71)), it could be expected that pooling of local anaesthetic in the dependent chest would be completely unimpeded. The dependent chest drain losses would therefore be expected to be high (to the detriment of analgesia), unless the patient is nursed supine (72)(73)(74)(75)(76), temporarily after bolusing, or continuously in the case of infusions.…”

Section: Intraflleural Anakesiamentioning

confidence: 99%

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Thoracic paravertebral analgesia

Richardson

Sabanathan

1995

Acta Anaesthesiol Scand

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Thoracic paravertebral nerve blockade, although once widely practised, has now only a few centres which contribute to the literature. Data production has, however, continued and this review correlates this new information with existing knowledge. Its history, taxonomy, anatomy, indications, techniques, mechanisms of analgesia, efficacy, contraindications, toxicity, side effects and complications are reviewed. Thoracic paravertebral analgesia is advocated for surgical procedures of the thorax and abdomen, especially wherever the afferent input is predominantly unilateral eg. thoracotomy, cholecystectomy and nephrectomy. It is also of benefit in the prevention and management of chronic pain. It is a simple undertaking with impressive efficacy. Plasma local anaesthetic levels are acceptable and its side effect and complication rates are low. No mortality has been reported. For unilateral surgery of the chest or truck, thoracic paravertebral analgesia should be considered as the afferent block of choice. For bilateral surgery, its efficacy may be limited by the doses of local anaesthetic which could safely be used and further study in this area in particular is required. This form of afferent blockade deserves greater consideration and investigation.

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Section: Intraflleural Anakesiamentioning

confidence: 99%

“…Some authors have found low pain scores following thoracotomy with intrapleural analgesia at rest (77,78). However, there is a disappointing lack of high quality of pain relief (72)(73)(74)(75)(76)(79)(80)(81), along with pulmonary function which is likewise disappointing (72,74,80).…”

Section: Intraflleural Anakesiamentioning

confidence: 99%

Thoracic paravertebral analgesia

Richardson

Sabanathan

1995

Acta Anaesthesiol Scand

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“…The interpleural administration of bupivacaine, most commonly by repeated bolus dose administration, has been used successfully for the management of postoperative pain following thoracic and upper abdominal surgery (Kambam et al, 1989;Reiestad et al, 1986;Str0mskag et al, 1988). A continuous interpleural infusion regimen might offer a clinical advantage over intermittent administration by providing a constant perineural bupivacaine concentration.…”

Section: Introductionmentioning

confidence: 99%

The disposition of bupivacaine following a 72 h interpleural infusion in cholecystectomy patients.

Kastrissios

Triggs

Mogg

et al. 1991

Brit J Clinical Pharma

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The disposition of bupivacaine and degree of analgesia following a 72 h interpleural infusion was investigated in 12 adult patients undergoing elective cholecystectomy. The infusion regimen of an initial interpleural bolus dose of 20 ml of 0.5% bupivacaine HCI with adrenaline (1:200,000) followed by continuous infusion at a rate of 8 ml h-1 of 0.25% plain bupivacaine HCI was designed to achieve continuous post-operative pain relief for 72 h. In practice an additional bolus dose (identical to the first) administered 5 h after infusion commencement was required to achieve adequate pain relief on the first postoperative day. The mean measured steady-state plasma bupivacaine concentration was 2.1 mg 1'1 (s.d. ± 0.54, range 1.3-3.2 mg 1-1). Disposition parameters for bupivacaine measured for the infusion were calculated by non-compartmental methods and compared with previous values obtained after single and multiple interpleural bolus dose administration. No statistically significant differences were noted and, in particular, the systemic clearance of bupivacaine (mean 10.2 1 h-' s.d ± 3.0; range 6.3-16.0 1 h-') remained unchanged following the long-term interpleural infusion. Analgesia was deemed satisfactory throughout the entire post-operative period.

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“…Up to 30% of the injected dose may be lost in the chest drain [2]. Another study noted that good pain relief from interpleural block was achieved in patients who underwent lateral and posterior thoracotomy, but not in those with anterior thoracotomy, or in patients in whom there was excessive bleeding into the pleural space [44]. Tartiere et al [45] studied the effectiveness of interpleural block after thoraco-abdominal incision for oesophagectomy.…”

Section: Thoracotomymentioning

confidence: 99%

Interpleural block – part 2

Dravid

Paul²

2007

Anaesthesia

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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

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Intrapleural Analgesia for Postthoracotomy Pain and Blood Levels of Bupivacaine Following Intrapleural Injection

Cited by 13 publications

References 0 publications

Thoracic paravertebral analgesia

Thoracic paravertebral analgesia

The disposition of bupivacaine following a 72 h interpleural infusion in cholecystectomy patients.

Interpleural block – part 2

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