Postoperative analgesia with intrapleural administration of bupivacaine‐adrenaline

Abstract

Twenty-one patients who underwent elective cholecystectomy were studied with regard to the effect of intrapleural administration of bupivacaine-adrenaline solution on postoperative pain and ventilatory capacity. Administration of 10 or 20 ml of 2.5 mg/ml or 5 mg/ml bupivacaine solution resulted in complete analgesia in 143 of 159 administrations. Most patients experienced the maximal pain-relieving effect within 1-2 min and analgesia persisted as a rule for 3-5 h. Forced vital capacity and forced expiratory volume in 1 s increased after intrapleural analgesia on average by 56% and 46%, respectively, on the first postoperative day and by 35% and 51%, respectively, on the second day. There was no significant difference in the analgesic effect or in the effect on the ventilatory capacity between the 2.5 mg/ml or the 5 mg/ml solution, in either the 10 ml or the 20 ml dose. Placebo (NaCl) given intrapleurally had no effect on pain or on the ventilatory capacity. The plasma concentration of bupivacaine after intrapleural administration showed a wide interindividual variation, with considerably higher average values when the 5 mg/ml solution had been used than for the 2.5 mg/ml solution. Although no toxic effects were noted, a 2.5 mg/ml solution, which can be given in an initial dose of 20 ml and top-up doses of 10 ml at 3-6 h intervals, is recommended. In four patients minor pneumothorax developed when the catheter was introduced. The pneumothorax was easily evacuated, but underlines the need for great care when introducing the catheter.

Bloqueio pleural bilateral: analgesia e funções pulmonares em pós-operatório de laparotomias medianas

“…In our series of 21 patients, only one has referred 10 hours relief and 2 patients 8 hours relief during the 62 bupivacaine blockades in which results have been extremely significant for bupivacaine (p < 0.001) (Table II) as compared to saline. In evaluating analgesia promoted by saline, there has been decrease of just one PHS level (Tables II and V) after five pleural blocks, different from Brismar et al 25 findings. In both cases, the small series of pleural blocks with saline solution was interrupted to prevent prolonged suffering of patients medicated with placebo in the immediate postoperative period when pain is more severe in the first 48 hours.…”

“…Nessa série de 21 pacientes, apenas um manifestou alívio de 10 horas e dois pacientes um alívio de oito horas de duração durante os 62 bloqueios com a bupivacaína em que o resultado foi extremamente significativo para a bupivacaína (p < 0,001) (Tabela II) quando comparada à solução fisiológica. Durante a avaliação da analgesia pela solução fisiológica, observou-se diminuição de apenas um único nível da EPH (Tabelas II e IV) após cinco bloqueios pleurais, diferente do que Brismar e col. 25 constataram. Em ambos os casos, a pequena série de bloqueios pleurais com a solução fisiológica foi interrompida para evitar o prolongado sofrimento dos pacientes medicados com placebo durante o período pós-operatório imediato, quando a dor é mais intensa (nas primeiras 48 horas).…”

Paravertebral blockade

“…epidural, intrapleural or intercostal blocks [l l-13, [24][25][26]. Although paravertebral block can be used for a wide variety of procedures there are some contraindications to its use in thoracic surgery.…”

Interpleural analgesia improves pulmonary function after cholecystectomy

“…The quality of analgesia obtained in our study is consistent with that reported by others. [7][8][9] Ventilatory function was better maintained in patients receiving interpleural bupivacaine as demonstrated by the reduction of FVC (22 per cent) and FEV t.o (25 per cent) observed in this group compared with Group 2 (decreased FVC of 32 per cent and decreased FEVI.o of 38 per cent). These are in accord with similar reports.…”

“…4-7 Although experience is still limited with the last technique, inserting a catheter using a closed chest technique is questionable because of the reported incidence of pneumothorax which may be as high as 20 per cent. 8 The present study was designed to determine the efficacy of interpleural bupivacaine compared with intramuscular meperidine for pain relief and preservation of pulmonary function after cholecystectomy. We have also evaluated the incidence of pneumothorax using a closed chest technique for interpleural catheter placement.…”