Intrapleural Bupivacaine vs Saline After Thoracotomy - Effects on Pain and Lung Function - A Double Blind Study

Symreng, Tommy; Gomez, Mark N.; Johnson, B; Rossi, Nicholas P.

doi:10.1213/00000539-198802001-00227

Cited by 18 publications

(15 citation statements)

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“…Our results showed that IPA was effective in thoracoscopic sympathectomy performed for primary palmar hyperhidrosis. Contrary to results in open thoracotomies [13], we found a prolonged effect obtained by a single dose of analgesic administered at the end of the surgical procedure. This may be explained by the direct contact of the analgesic fluid with the open extrapleural parietal space and the absence of drainage tubes.…”

Section: Discussioncontrasting

confidence: 99%

Intrapleural analgesia following thoracoscopic sympathectomy for palmar hyperhidrosis

et al. 2003

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Section: Discussioncontrasting

confidence: 99%

Intrapleural analgesia following thoracoscopic sympathectomy for palmar hyperhidrosis

et al. 2003

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“…The drains (mediastinal and/or pleural) were routinely removed on POD2 and all patients were submitted to a physical therapy program until hospital discharge (breathing exercises and early deambulation). Chest pain sensation was assessed on 1, 3 and 5 PODs, and quantified by a modified standard score (0 = no pain to 10 = unbearable pain) [7]. This evaluation was performed at rest before the measurement of respiratory muscle strength.…”

Section: Postoperative Managementmentioning

confidence: 99%

Dreno pleural subxifoide confere menor comprometimento da força muscular respiratória, oxigenação e menor dor torácica após cirurgia de revascularização do miocárdio sem circulação extracorpórea

Cancio¹,

Guizilini²,

Bolzan³

et al. 2012

Rev Bras Cir Cardiovasc

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Dreno pleural subxifoide confere menor comprometimento da força muscular respiratória, oxigenação e menor dor torácica após cirurgia de revascularização do miocárdio sem circulação extracorpórea: estudo controlado randomizado Subxyphoid pleural drain confers lesser impairment in respiratory muscle strength, oxygenation and lower chest pain after off-pump coronary artery bypass grafting: a randomized controlled trial Abstract Objective: To evaluate respiratory muscle strength, oxygenation and chest pain in patients undergoing off-pump coronary artery bypass (OPCAB) using internal thoracic artery grafts comparing pleural drain insertion site at the subxyphoid region versus the lateral region.Methods: Forty patients were randomized into two groups in accordance with the pleural drain site. Group II (n = 19) -pleural drain exteriorized in the intercostal space; group (SI) (n = 21) chest tube exteriorized at the subxyphoid region. All patients underwent assessment of respiratory muscle strength (inspiratory and expiratory) on the pre, 1, 3 and 5 postoperative days (POD). Arterial blood gas analysis was collected on the pre and POD1. The chest pain sensation was measured 1, 3 and 5 POD.Results: A significant decrease in respiratory muscle strength (inspiratory and expiratory) was seen in both groups until POD5 (P <0.05). When compared, the difference between groups remained significant with greater decrease in the II (P <0.05). The blood arterial oxygenation fell in both groups (P <0.05), but the oxygenation was lower in the II (P <0.05). Referred chest pain was higher 1, 3 and 5 POD in the II group (P <0.05). The orotracheal intubation time and postoperative length of hospital stay were higher in the II group (P <0.05).Conclusion: Patients submitted to subxyphoid pleural drainage showed less decrease in respiratory muscle strength, better preservation of blood oxygenation and reduced thoracic pain compared to patients with intercostal drain on early OPCAB postoperative. 104Cancio ASA, et al. -Subxyphoid pleural drain confers lesser impairment in respiratory muscle strength, oxygenation and lower chest pain after off-pump coronary artery bypass grafting: a randomized controlled trial Bras Cir Cardiovasc 2012;27(1):103-9 Rev

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“…Patients who did not receive pleural lignocaine used three times as much morphine as those who received pleural lignocaine. Other studies have found improved analgesia and improved postoperative pulmonary function after upper abdominal or thoracic surgery with the use of pleural analgesia (Symreng, Gomez & Rossi 1989;VadeBoncouer et al 1989;Frenette, Boudreault & Guay 1991;Mann et aZ: 1992). Although most authors have placed bupivacaine in the pleural space, we chose lignocaine because of the ease of assessing serum levels and the higher therapeutic index of lignocaine over bupivacaine.…”

Section: Discussionmentioning

confidence: 94%

“…In 1986 Reiestad et al reported using 20 ml of 0.5% bupivacaine with adrenaline administered into the pleural cavity of adults to produce up to 10 h of thoracic analgesia (Reiestad, Stromskag &z Holmqvist 1986). Since this initial publication, several authors have utilized pleural bupivacaine in both children and adults to provide postthoracotomy analgesia (McIlvaine et al 1988;El-Naggar 1989;Symreng, Gomez & Rossi 1989;Shafei et al 1990;Tobias 1991;Mann ef al. 1992).…”

Section: Introductionmentioning

confidence: 99%

The safety of continuous pleural lignocaine after thoracotomy in children and adolescents

Stayer

Pasquariello

Schwartz

et al. 1995

Pediatric Anesthesia

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Several studies have proven pleural bupivacaine effectively provides postthoracotomy analgesia for both children and adults. When 0.25% bupivacaine is administered as a continuous infusion or repeated bolus, serum bupivacaine levels frequently approach the toxic range. The hazards of bupivacaine toxicity are more difficult to monitor, especially in children who may not report symptoms of local anaesthetic toxicity. Because of this concern, we initiated the use of pleural lignocaine to provide postthoracotomy analgesia for paediatric patients. The records of all patients receiving pleural lignocaine from January 1991 to December 1992 were reviewed. A total of 98 pleural catheters were inserted in 96 patients ranging in age from five months to 20 years. Seven patients had lignocaine levels that exceeded 5 micrograms.ml-1 and no patient manifested symptoms of systemic toxicity. This study shows that the administration of pleural lignocaine is a safe method of providing postthoracotomy analgesia. Lignocaine infusions in the dosage range of 20 to 40 micrograms.kg-1.min-1 rarely produce toxic levels, and monitoring of lignocaine levels every 12 h is an effective method of screening for toxicity.

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Intrapleural Bupivacaine vs Saline After Thoracotomy - Effects on Pain and Lung Function - A Double Blind Study

Cited by 18 publications

References 0 publications

Intrapleural analgesia following thoracoscopic sympathectomy for palmar hyperhidrosis

Intrapleural analgesia following thoracoscopic sympathectomy for palmar hyperhidrosis

Dreno pleural subxifoide confere menor comprometimento da força muscular respiratória, oxigenação e menor dor torácica após cirurgia de revascularização do miocárdio sem circulação extracorpórea

The safety of continuous pleural lignocaine after thoracotomy in children and adolescents

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