title: Continuous interpleural infusion of bupivacaine for postoperative analgesia after surgery with flank incisions: a double-blind comparison of 0.25% and 0.5% solutions.
abstract: Postoperative analgesia, as assessed by visual analogue scale scores (0-10) and patient-controlled analgesia morphine requirements, pulmonary function (forced vital capacity and forced expiratory volume in 1 s), and plasma bupivacaine concentrations were studied in patients receiving interpleural blockade with bupivacaine after surgery with a flank incision. Two groups of 10 patients received either 0.5% or 0.25% bupivacaine, both with epinephrine (5 micrograms/mL). Pain relief was initiated when patients had visual analogue scale scores greater than or equal to 4. Patients received 21 mL of bupivacaine 0.25% or 0.5% in a double-blind fashion. One hour later, a continuous infusion of 5 mL/h of the study solution was started. At the same time, patient-controlled analgesia became accessible to the patients. The onset time of pain relief and the area under the visual analogue scale score-time curves over the first 8 h were similar in both groups. Patient-controlled analgesia morphine use was also similar in the 0.25% (21.3 +/- 14.6 mg) and 0.5% (21.0 +/- 16.0 mg) groups (mean +/- SD). In both groups, forced vital capacity and forced expiratory volume in 1 s improved significantly within 60 min (P less than 0.05). Peak plasma concentrations (Cmax) and the area under the plasma concentration-time curve (AUC) over 24 h were higher (P less than 0.001) in the 0.5% group (Cmax, 1.47 +/- 0.37 micrograms/mL; AUC, 1511 +/- 323 micrograms.mL-1.min) than those in the 0.25% group (Cmax, 0.55 +/- 0.22 micrograms/mL; AUC, 680 +/- 118 micrograms.mL-1.min) (mean +/- SD).(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Anesthesiology, Leiden University Hospital, The Netherlands.
authors.forename: J W
authors.initials: JW
authors.lastname: van Kleef
authors.forename: E A
authors.initials: EA
authors.lastname: Logeman
authors.forename: A G
authors.initials: AG
authors.lastname: Burm
authors.forename: J W
authors.initials: JW
authors.lastname: de Voogt
authors.forename: R A
authors.initials: RA
authors.lastname: Mooren
authors.forename: I M
authors.initials: IM
authors.lastname: van Kleef-Mannot
mesh_terms: D000328:Adult; D002045:Bupivacaine / Q000008:administration & dosage*; D004311:Double-Blind Method; D006801:Humans; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control*; D010994:Pleura; D012996:Solutions; D013514:Surgical Procedures, Operative; D013997:Time Factors
chemical_list: D012996:Solutions; D002045:Bupivacaine