Interpleural administration of bupivacaine after cholecystectomy: a comparison with intercostal nerve block.
Pethidine requirements and verbal pain scores were recorded in 36 patients after cholecystectomy via subcostal incision. All patients also received 20 ml 0.5% bupivacaine with adrenaline 1/200,000. Group 1 (12 patients) received unilateral intercostal nerve blocks. Interpleural catheters were inserted through the 8th intercostal space in the remaining patients; 12 received local anaesthetic via the catheter immediately after surgery (Group 2) and 12 were given local anaesthetic at three hours (Group 3). Small asymptomatic pneumothoraces were noted on chest X-ray in six of the 24 patients with interpleural catheters. Both types of local anaesthesia produced lower pain scores than pethidine alone (P less than 0.05) with 25% of intercostal nerve blocks and 63% of interpleural catheters requiring no pethidine in the following three hours. The provision of catheter 'top-ups' between six and 18 hours after surgery also resulted in lower pain scores and a reduction in pethidine requirements (P less than 0.05).
Department of Anaesthesia, Prince Henry's Hospital, Melbourne, Australia.
D W
DW
Blake
G
G
Donnan
J
J
Novella
D000328:Adult; D000368:Aged; D000758:Anesthesia / Q000009:adverse effects; D002045:Bupivacaine / Q000008:administration & dosage* / Q000627:therapeutic use; D002404:Catheterization; D002763:Cholecystectomy; D005260:Female; D006801:Humans; D007367:Intercostal Nerves; D008297:Male; D008614:Meperidine / Q000627:therapeutic use; D008875:Middle Aged; D009407:Nerve Block; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000628:therapy; D010994:Pleura; D011030:Pneumothorax / Q000209:etiology; D013900:Thoracic Nerves
D008614:Meperidine; D002045:Bupivacaine