INTERPLEURAL ANALGESIA FOR BREAST SURGERY

Dear Editor,

Interpleural analgesia (IPA) for surgeries over areas innervated by intercostal nerves, is a relatively new technique described less than two decades ago [1]. The technique is simple, avoids multiple intercostal nerve blockade, allows catheter placement and therefore continuous and high quality analgesia. Adverse effects including pneumo-thorax are extremely uncommon. A brief account of a case is presented where IPA was used to provide analgesia following surgery on the breast.

A 49-year-old lady weighing 60 kg was posted for excision of a lump measuring 5×3 cm in breast on the right side. She was given anaesthesia in accordance with the standard policy. During surgery, the lump appeared to be precancerous hence a wide excision was carried out by extending the incision over upper quadrant upto anterior axillary line. After completion of the surgery the patient was turned into lateral decubitus position with operated side up and a mild head down till. A 16G catheter was passed in 7th intercostal space on the right side about 8 cm from central spine. The catheter was placed in the pleural cavity and secured. 20 mL of 0.5 per cent bupivacaine was injected after taking due precaution. After maintaining the position for 5 minutes, the patient was straightened and residual myoneural blockade was reversed. The patient remained absolutely comfortable for 24 hours and did not demand analgesia. There was no untoward event. After 24 hours, 10 mL of 0.5 per cent bupivacainc was repeated in the same position as described above and thereafter the catheter was removed. She did not require any analgesic medication subsequently and had an uneventful recovery.

IPA is now an acceptable technique of pain relief in surgeries on gall bladder and kidney, fracture of ribs and thoracotomies. However, it has been found to be equally effective in surgery on the breast. Schlesinger et al used IPA satisfactorily as the sole anaesthetic technique for mammography during needle localization and for subsequent breast biopsy [2]. Reistad and McIlvaine also found this technique causing complete skin anaesthesia over T-1 to T-9 dermatomes to allow breast surgery [3]. The technique does produce adequate analgesia as noted in outgoing report however it needs to be studied further. A study of interpleural analgesia in upper abdominal surgeries as compared to intramuscular pethidine is already underway at this hospital and preliminary results arc expected to be published soon.