Continuous intercostal analgesia with 0.5% bupivacaine after thoracotomy: a randomized study.
This study was undertaken to evaluate the effectiveness of 0.5% bupivacaine (360 mg/day) as a continuous infusion through an indwelling intercostal catheter inserted intraoperatively in the management of pain after thoracotomy. Eighty-six patients were randomized into three groups: group 1 = intercostal bupivacaine, group 2 = intercostal saline solution, and group 3 = fixed-schedule intramuscular buprenorphine. Supplementary buprenorphine was given as required. Pain and pulmonary function were assessed throughout the first 5 days after operation. Pain score was lower in group 1 than in group 2 for the first 8 hours after operation (p < 0.02). During the first 3 postoperative days, mean postoperative pain scores of 5 or more were recorded in 9% of group 1 patients versus 40% of group 2 patients (p < 0.05) and 13% of group 3 patients (not significant). Total doses of buprenorphine were lower in groups 1 and 2 than in group 3 (p < 0.001). No between-group differences in pulmonary function were observed. Respiratory complications occurred in no patients in groups 1 and 3 versus 5 in group 2 (p < 0.05). Continuous intercostal bupivacaine provided similar early pain control as compared with fixed-schedule narcotics but induced better analgesia with fewer complications than on-demand narcotics alone (group 2).
Deneuville
M
M
Départment de Kinesitherapie, Centre Chirurgical Marie Lannelongue, Université Paris-Sud, Le Plessis Robinson, France.
Bisserier
A
A
Regnard
J F
JF
Chevalier
M
M
Levasseur
P
P
Hervé
P
P
D000698:Analgesia; D002045:Bupivacaine / Q000008:administration & dosage*; D002047:Buprenorphine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000628:therapy*; D013908:Thoracotomy
D002047:Buprenorphine; D002045:Bupivacaine