Pain relief for thoracotomy. Comparison of morphine requirements using an extrapleural infusion of bupivacaine.
OBJECTIVE
The effectiveness of a continuous infusion of extrapleural bupivacaine for relief of postoperative pain was assessed in patients undergoing posterolateral thoracotomy under general anesthesia by comparing morphine requirements.


METHODS
Bupivacaine 0.25% was infused at a rate of 5 mL/h through an unkinkable extrapleural catheter that was sited under direct vision at operation.


RESULTS
Mean (+/- SD) 24-hour requirements for morphine from a patient-controlled analgesia device were 39 +/- 15 mg for the treated group and 69 +/- 26 mg in the control group (P < .006). Patients in the treated group recorded significantly smaller visual analog scores for pain both at rest (P < .005) and on movement (P < .03) compared to the control group. There were no adverse effects associated with the use of extrapleural bupivacaine in this study.


CONCLUSIONS
Continuous extrapleural infusion of bupivacaine through unkinkable catheters sited during thoracotomy resulted in decreased intravenous patient-controlled analgesia use and decreased verbal categoric pain scores at rest and during movement.
Department of Clinical Anaesthesia, Royal Group of Hospitals, Belfast, Northern Ireland.
U A
UA
Carabine
H
H
Gilliland
J R
JR
Johnston
J
J
McGuigan
D000328:Adult; D000368:Aged; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000768:Anesthesia, General; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D002404:Catheterization / Q000295:instrumentation; D005260:Female; D006801:Humans; D007267:Injections / Q000295:instrumentation; D007275:Injections, Intravenous; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D009068:Movement; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D010994:Pleura; D012146:Rest; D013908:Thoracotomy / Q000009:adverse effects*
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D002045:Bupivacaine