title: Interpleural bupivacaine for pain relief after transthoracic endoscopic sympathectomy for primary hyperhidrosis.
abstract: BACKGROUND
  Interpleural local anesthetic has been reported to provide good postoperative pain relief in patients receiving thoracotomy or upper abdominal surgery. However, there were few reports regarding interpleural local anesthetic for postoperative pain relief in patients receiving transthoracic endoscopic sympathectomy for palmar hyperhidrosis. The aim of the present study was to evaluate the effect of interpleural bupivacaine for postoperative pain relief in patients receiving transthoracic endoscopic sympathectomy for palmar hyperhidrosis.
  
  
  METHODS
  Sixty adult patients undergoing bilateral transthoracic endoscopic sympathectomy were randomly divided into two groups (n = 30, each group) for study. At the end of surgery, patients in group 1 were given bilaterally an injection of 0.5% interpleural bupivacaine (10 ml) through the surgical endoscope, whereas those in the group 2 who were not given any treatment at the juncture served as control. Postoperatively, intravenous morphine 2.5 mg was given luxuriously to the patients at their request at intervals of 30 min. The intensity of postoperative pain was assessed at rest and during cough with visual analogue scale (VAS, 0-10 points).
  
  
  RESULTS
  It was showed that at rest the pain scores were less in group 1 than in group 2 within 4 h postoperatively. During cough, group 1 also had less VAS scores than group 2 within 5 h postoperatively. Furthermore, patients in group 1 consumed less intravenous morphine than those in group 2 within 6 h postoperatively.
  
  
  CONCLUSIONS
  Interpleural bupivacaine significantly decreased the intensity of postoperative pain and morphine consumption in patients undergoing transthoracic endoscopic sympathectomy for palmar hyperhidrosis. We are looking forward to seeing that with the addition of epinephrine to the anesthetic solution and a considerable increase of dosage and/or volume of bupivacaine may provide a better and longer pain relief, about which further studies are needed.
authors.affiliation: Division of Anesthesiology, 804 Army General Hospital, Taipei, Taiwan, R.O.C.
authors.forename: F J
authors.initials: FJ
authors.lastname: Lieou
authors.forename: S C
authors.initials: SC
authors.lastname: Lee
authors.forename: S T
authors.initials: ST
authors.lastname: Ho
authors.forename: J J
authors.initials: JJ
authors.lastname: Wang
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D004724:Endoscopy; D005260:Female; D006801:Humans; D006945:Hyperhidrosis / Q000601:surgery*; D008297:Male; D010149:Postoperative Pain / Q000188:drug therapy*; D010994:Pleura; D013562:Sympathectomy
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine