Pain Management by the Longitudinal Introducing Method of an Extrapleural Catheter after Thoracotomy.
10.4097/kjae.1999.37.4.624
- Author:
Tae Yop KIM
1
;
Sung Soo LEE
;
Myoung Keun SHIN
Author Information
1. Department of Anesthesiology, Samsung Hospital, Sungkyunkwan University School of Medicine, Masan, Korea.
- Publication Type:Original Article
- Keywords:
Analgesia, postoperative;
Anesthetics, local, bupivacaine;
Anesthetic techniques, regional, intercostal, extrapleural;
Lung, pulmonary function
- MeSH:
Analgesia;
Anesthesia;
Anesthetics;
Anesthetics, Local;
Arterial Pressure;
Bupivacaine;
Catheters*;
Cough;
Epinephrine;
Heart Rate;
Humans;
Intercostal Muscles;
Intercostal Nerves;
Pain Management*;
Pain, Postoperative;
Pleura;
Respiration;
Thoracic Cavity;
Thoracotomy*
- From:Korean Journal of Anesthesiology
1999;37(4):624-630
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Sufficient accumulations of local anesthetics in the extrapleural space promotes effective access to several intercostal nerves and, consequently, analgesia. The total volume of leakage of these anesthetics from the space can depend on the technique of extrapleural catheter insertion which is chosen. METHODS: Twenty patients due for thoracotomy were randomly selected to be provided with postoperative pain relief by an extrapleural approach. Before the thoracic cavity was closed, appropriate spaces between parietal pleura and intercostal muscle were made with surgical dilators under direct vision. An epidural catheter was introduced at a longitudinal lie in a cephalad direction, before the thoracic cavity was closed. Bupivacaine 0.25%, with 1 : 200,000 epinephrine was injected in a 10 ml dose about 20 minutes before the end of anesthesia, and infused at a rate of 0.88 mg/kg/hour for 1 hour, 0.35 mg/kg/hour for 23 hours and 0.3 mg/kg/hour for the second day postoperatively. RESULTS: The degree of analgesia with coughing and deep breathing was satisfactory to patients and thoracic surgeons. The average numbers of analgesic dermatomes obtained by pinprick tests, VAS, and Prince Henry pain scores were 5.2 0.5, 2.0 0.5 cm and 1.6 0.6, respectively. Changes in mean arterial pressure were insignificant, and heart rate increased at the postoperative hours of 1, 4 and 8 (P value < 0.05). FVC and FEV1 were restored to levels up to 67.2 and 71.0% of their preoperative values at the postoperative hour of 48. CONCLUSIONS: These results suggest that the technique of a catheter introduced at a longitudinal lie in a cephalad direction was effective and clinically useful for pain relief following thoracotomy regardless of some leakage of bupivacaine.
