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. 1991 Jan;46(1):21–24. doi: 10.1136/thx.46.1.21

Continuous extrapleural intercostal nerve block after pleurectomy.

E J Mozell 1, S Sabanathan 1, A J Mearns 1, P J Bickford-Smith 1, M R Majid 1, G Zografos 1
PMCID: PMC1020908  PMID: 1871692

Abstract

A randomised, double blind trial was carried out in 16 patients undergoing pleurectomy to assess the effect of continuous extrapleural intercostal block on postoperative pain and pulmonary function. Subjective pain relief was assessed on a linear visual analogue scale. Pulmonary function was measured on the day before operation and daily for five days after surgery. Eight patients received bupivacaine and eight placebo (saline). The mean pain scores at 4, 8, 16, and 24 hours were 13.3, 8.5, 6.1, and 10 mm respectively in the bupivacaine group compared with 56.3, 41, 46.7, and 35 in the control group; in addition, the bupivacaine group required less papaveretum. Twenty four hours after surgery mean values of peak expiratory flow, forced expiratory volume in one second, and forced vital capacity were reduced to 82%, 76%, and 76% of preoperative control values in the bupivacaine group, and to 39%, 32%, and 36% in the control group. The speed of recovery of pulmonary function was superior in the bupivacaine group. There were no complications related to the infusion. Continuous extrapleural intercostal nerve blockade with bupivacaine provides safe and effective postoperative analgesia and improves respiratory mechanics after pleurectomy.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ali J., Weisel R. D., Layug A. B., Kripke B. J., Hechtman H. B. Consequences of postoperative alterations in respiratory mechanics. Am J Surg. 1974 Sep;128(3):376–382. doi: 10.1016/0002-9610(74)90176-7. [DOI] [PubMed] [Google Scholar]
  2. Almind M., Lange P., Viskum K. Spontaneous pneumothorax: comparison of simple drainage, talc pleurodesis, and tetracycline pleurodesis. Thorax. 1989 Aug;44(8):627–630. doi: 10.1136/thx.44.8.627. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bartlett R. H., Brennan M. L., Gazzaniga A. B., Hanson E. L. Studies on the pathogenesis and prevention of postoperative pulmonary complications. Surg Gynecol Obstet. 1973 Dec;137(6):925–933. [PubMed] [Google Scholar]
  4. Catley D. M., Thornton C., Jordan C., Lehane J. R., Royston D., Jones J. G. Pronounced, episodic oxygen desaturation in the postoperative period: its association with ventilatory pattern and analgesic regimen. Anesthesiology. 1985 Jul;63(1):20–28. doi: 10.1097/00000542-198507000-00004. [DOI] [PubMed] [Google Scholar]
  5. Craig D. B. Postoperative recovery of pulmonary function. Anesth Analg. 1981 Jan;60(1):46–52. [PubMed] [Google Scholar]
  6. Eason M. J., Wyatt R. Paravertebral thoracic block-a reappraisal. Anaesthesia. 1979 Jul-Aug;34(7):638–642. doi: 10.1111/j.1365-2044.1979.tb06363.x. [DOI] [PubMed] [Google Scholar]
  7. Fairley H. B. Oxygen therapy for surgical patients. Am Rev Respir Dis. 1980 Nov;122(5 Pt 2):37–44. doi: 10.1164/arrd.1980.122.5P2.37. [DOI] [PubMed] [Google Scholar]
  8. GAENSLER E. A. Parietal pleurectomy for recurrent spontaneous pneumothorax. Surg Gynecol Obstet. 1956 Mar;102(3):293–308. [PubMed] [Google Scholar]
  9. Harvey J. E., Jeyasingham K. The difficult pneumothorax. Br J Dis Chest. 1987 Jul;81(3):209–216. doi: 10.1016/0007-0971(87)90152-5. [DOI] [PubMed] [Google Scholar]
  10. Jenkins S. C., Barnes N. C., Moxham J. Evaluation of a hand-held spirometer, the Respiradyne, for the measurement of forced expiratory volume in the first second (FEV1), forced vital capacity (FVC) and peak expiratory flow rate (PEFR). Br J Dis Chest. 1988 Jan;82(1):70–75. doi: 10.1016/0007-0971(88)90010-1. [DOI] [PubMed] [Google Scholar]
  11. Kambam J. R., Hammon J., Parris W. C., Lupinetti F. M. Intrapleural analgesia for post-thoracotomy pain and blood levels of bupivacaine following intrapleural injection. Can J Anaesth. 1989 Mar;36(2):106–109. doi: 10.1007/BF03011428. [DOI] [PubMed] [Google Scholar]
  12. Meyers J. R., Lembeck L., O'Kane H., Baue A. E. Changes in functional residual capacity of the lung after operation. Arch Surg. 1975 May;110(5):576–583. doi: 10.1001/archsurg.1975.01360110122020. [DOI] [PubMed] [Google Scholar]
  13. Orr I. A., Keenan D. J., Dundee J. W. Improved pain relief after thoracotomy: use of cryoprobe and morphine infusion. Br Med J (Clin Res Ed) 1981 Oct 10;283(6297):945–948. doi: 10.1136/bmj.283.6297.945. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Rooney S. M., Jain S., McCormack P., Bains M. S., Martini N., Goldiner P. L. A comparison of pulmonary function tests for postthoracotomy pain using cryoanalgesia and transcutaneous nerve stimulation. Ann Thorac Surg. 1986 Feb;41(2):204–207. doi: 10.1016/s0003-4975(10)62670-7. [DOI] [PubMed] [Google Scholar]
  15. Rosenberg P. H., Scheinin B. M., Lepäntalo M. J., Lindfors O. Continuous intrapleural infusion of bupivacaine for analgesia after thoracotomy. Anesthesiology. 1987 Nov;67(5):811–813. doi: 10.1097/00000542-198711000-00034. [DOI] [PubMed] [Google Scholar]
  16. Sabanathan S., Mearns A. J., Bickford Smith P. J., Eng J., Berrisford R. G., Bibby S. R., Majid M. R. Efficacy of continuous extrapleural intercostal nerve block on post-thoracotomy pain and pulmonary mechanics. Br J Surg. 1990 Feb;77(2):221–225. doi: 10.1002/bjs.1800770229. [DOI] [PubMed] [Google Scholar]
  17. Sabanathan S., Smith P. J., Pradhan G. N., Hashimi H., Eng J. B., Mearns A. J. Continuous intercostal nerve block for pain relief after thoracotomy. Ann Thorac Surg. 1988 Oct;46(4):425–426. doi: 10.1016/s0003-4975(10)64657-7. [DOI] [PubMed] [Google Scholar]
  18. Shulman M., Sandler A. N., Bradley J. W., Young P. S., Brebner J. Postthoracotomy pain and pulmonary function following epidural and systemic morphine. Anesthesiology. 1984 Nov;61(5):569–575. doi: 10.1097/00000542-198411000-00017. [DOI] [PubMed] [Google Scholar]
  19. Smith G. Management of post-operative pain. Can J Anaesth. 1989 May;36(3 Pt 2):S1–S4. doi: 10.1007/BF03005318. [DOI] [PubMed] [Google Scholar]
  20. Toledo-Pereyra L. H., DeMeester T. R. Prospective randomized evaluation of intrathoracic intercostal nerve block with bupivacaine on postoperative ventilatory function. Ann Thorac Surg. 1979 Mar;27(3):203–205. doi: 10.1016/s0003-4975(10)63275-4. [DOI] [PubMed] [Google Scholar]
  21. Weeden D., Smith G. H. Surgical experience in the management of spontaneous pneumothorax, 1972-82. Thorax. 1983 Oct;38(10):737–743. doi: 10.1136/thx.38.10.737. [DOI] [PMC free article] [PubMed] [Google Scholar]

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