Intrapleural Bupivacaine Analgesia in Thoracotomy

Abstract

Post-operative pain after thoracotomy should be controlled for adequate respiratory effort, for this intraplueral bupivacaine was tried in this study and also evaluated complications and effectiveness. Intrapleural space anatomy explained, pharmacology of bupivacaine and its dose and toxicity explained. Previous studies on intraplueral bupivacaine reviewed. 50 cases that underwent thoracotomy with a male to female ratio 24:76. Under general anesthesia before closure of chest, surgeon inserts a Epidural catheter of 16 FG or a vacuum drain catheter of 12 or 14 FG into intraplueral space. After surgery 0.375% bupivacine 15-20 ml injected, clamping the chest drain tube for 10 minutes. Duration for onset of action found to be more in first dose compared to second and third dose. Duration of action was found to be average 6 hours. Pain control was found to improve from first to fourth dose with visual analogue scale. Respiratory rate also improved. There was only 10 mmHg BP change. Supplemental analgesic was needed only in 16% of patients. Concluding that intra pleural bupivacaine is technically simple and highly efficient for controlling post thoracotomy pain improving the respiratory effort. KEYWORDS: Intrapleural, bupivacaine, thoracotomy, visual analogue scale. INTRODUCTION:Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage 1 it is one of the commonest symptom to lead a patient to seek medical advice, whatever the cause, it demands relief.The need for adequate post-operative pain control, in order to ensure adequate respiratory effort, have been recognized for years. Following thoracotomy there is reduction in lung volumes. This result in generation of ineffective cough as well as to the collapse of alveoli which leads to pneumonia and reduction in arterial partial pressure of oxygen. 2 Adequate analgesia would facilitate deep breathing and clearing of secretions from the airway. Vigorous chest physiotherapy, deep breathing exercises, coughing and early mobilization can be undertaken effectively only after adequate analgesia has been achieved.The traditional use of parental opiates often does not provide adequate pain relief. Other methods like, Patient controlled analgesia (PCA) in which patient controls the rate of intravenous opioid infusion. Intercostal nerve blocks, Thoracic epidural, Opioids in the epidural space, and transcutaneous electrical nerve stimulation, can produce adequate analgesia but have their limitations along with possible side effects. Centrally acting analgesics produce hypoventilation due to their sedative and depressant actions by reducing respiratory rate and diminishing tidal volume. Recently, 3 developed a new technique for sole treatment of postoperative pain relief i. e., Intrapleural Block.This technique involves the insertion of an extradural catheter into the pleural space and the administration of local anaesthetic through the catheter. The technique has the advantage of only sin...