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

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.

Hemodynamic effects of interpleural analgesia in pigs.

Six anesthetized pigs received bupivacaine 2 mg/kg with epinephrine 2 micrograms/kg interpleurally while six saline injected animals served as controls. The animals were monitored hemodynamically for 120 min after injection. There were no significant changes in hemodynamic variables in the control group. In the group receiving bupivacaine with epihephrine there was a pattern of increase in mean arterial blood pressure, systemic vascular resistance and mean pulmonary arterial blood pressure after 60 min of observation. There were no other significant changes in pulmonary or systemic hemodynamics or gas exchange as evaluated by blood gases or whole body oxygen consumption. It is speculated that the increased systemic vascular resistance was an effect of the epinephrine added to the anesthetic. Interpleural analgesia may be a safe pain-relieving method even in slightly hypovolemic individuals.

Interpleural analgesia in the treatment of severe thoracic postherpetic neuralgia.

Effective, long-lasting pain relief was produced in 26 patients suffering from severe thoracic postherpetic neuralgia by intermittent administration of local anesthetics into the pleural space through a percutaneously placed interpleural catheter. The duration of treatment varied from seven to 21 days. During this period, 30 ml of 0.5% bupivacaine with epinephrine (5 micrograms/ml) were injected every 24 hours. The injections were continued for three days after the patients were pain free or had reached an analgesic plateau. All patients achieved good to excellent pain relief. During a follow-up period of five to 15 months, their level of pain has not increased from the level achieved at the end of the treatment program.

Successful treatment of chronic pancreatitis pain with interpleural analgesia.

Interpleural analgesia has recently been shown to be effective in the management of various chronic pain syndromes. We have used interpleural analgesia successfully in 11 patients with severe chronic pancreatitis of 24-38 months' duration. Daily injections of 30 ml of 0.5 per cent bupivacaine with epinephrine 5 mu.ml-1, were given through a percutaneously inserted pleural catheter over a five- to ten-day period. Patients have remained pain-free during follow up which ranges from 24 to 40 weeks. This method of providing analgesia for the patient suffering from the pain of chronic pancreatitis is simple, safe, effective and can be provided on an outpatient basis.

Pleural analgesia for the treatment of acute severe thoracic herpes zoster.

Effective pain relief was produced in 18 patients having acute or subacute thoracic herpes zoster by the intermittent administration of local anesthetics into the pleural space via a percutaneously placed catheter. The duration of treatment varied from 16 to 21 days. During this period, the intervals between subsequent doses of 20 ml of 0.5% bupivacaine with 1:200,000 epinephrine increased in all patients from two doses per 24 hours to one dose per 24 hours. Patients became pain-free between 16 and 21 days after the beginning of treatment. The catheters were then removed, and a follow-up period of more than one year showed no signs of postherpetic neuralgia in any of the 18 patients. No side effects were observed during the treatment period.

Intrapleural administration of 0.25%, 0.375%, and 0.5% bupivacaine with epinephrine after cholecystectomy.

Thirty patients who had undergone cholecystectomy (subcostal incision) were randomly allocated to three groups of ten patients each and given intrapleural injections of 20 ml 0.25% (group I), 0.375% (group II), or 0.5% (group III) bupivacaine each with added epinephrine (5 micrograms/ml). Complete pain relief was obtained within 30 minutes in all but one patient in groups I and II. Pain scores (VAS, 0-100 mm) were recorded at regular intervals and did not exceed 20 mm (mean) in any group from 30 minutes up to 4 hours. Median time interval from the intrapleural injection to administration of supplementary analgesics was 4 hours 20 minutes, 6 hours, and 7 hours 45 minutes in groups I, II, and III, respectively. The maximum plasma concentration of bupivacaine (Cmax), 0.62 (+/- 0.25 SD) microgram/ml in group I, 0.82 (+/- 0.40) microgram/ml in group II, and 1.20 (+/- 0.44) microgram/ml in group III, was significantly higher in group III than in the other groups. The time to achieve maximum plasma concentration of bupivacaine (Tmax) was approximately 15 minutes in all groups. No side effects were observed.