[Intrapleural analgesia].
Interpleural analgesia, a recently devised method for postoperative analgesia, consists of the injection of a local anaesthetic into the pleural space. The technique of the catheter insertion is simple and derived from the threadening of an epidural catheter, using the same equipment. An unilateral analgesia is obtained with a rapid onset but not efficient enough for a surgical procedure. The area covered by analgesia includes the thorax and the upper part of the abdomen. No haemodynamic adverse effects occur and ventilatory function is rather improved. The main mechanism of analgesia is probably a retrograde intercostal nerve blockade. Although the exact dose and volume of local anaesthetic is still controversial, 20 to 30 mL of 0.5% bupivacaine is very likely the most convenient. Lidocaine may also be administered at the dose of 2 mg.kg-1 of a 2% solution. Main indications of interpleural analgesia are cholecystectomies and thorax trauma patients. Adverse effects and hazards are uncommon and include mainly pneumothorax and toxic effects of a local anaesthetic overdose.
Orliaguet
G
G
Département d'Anesthésie-Réanimation, Hôpital Necker, Paris.
Carli
P
P
D000698:Analgesia / Q000379:methods*; D002045:Bupivacaine / Q000008:administration & dosage* / Q000493:pharmacokinetics; D002763:Cholecystectomy; D000075202:Contraindications; D006801:Humans; D007367:Intercostal Nerves; D008012:Lidocaine / Q000008:administration & dosage* / Q000493:pharmacokinetics; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy*; D010994:Pleura; D012119:Respiration / Q000187:drug effects; D013898:Thoracic Injuries / Q000188:drug therapy; D013908:Thoracotomy
D008012:Lidocaine; D002045:Bupivacaine
Analgésie interpleurale.