Pleural bupivacaine placement for optimal postthoracotomy pulmonary function: a prospective, randomized study.
OBJECTIVE
To determine dependent chest tube losses of bupivacaine with paravertebral versus interpleural administration, thereby helping to explain the significant differences in pulmonary function that exist between these two techniques.


METHODS
A prospective, randomized study.


METHODS
A single hospital.


METHODS
Twelve adult patients undergoing posterolateral thoracotomies.


METHODS
Paravertebral or interpleural administration of bupivacaine.


RESULTS
Analgesia, as assessed by visual analog pain scores and patient-controlled morphine requirements, was similar in both groups. Postoperative spirometric values were significantly better at most times with the paravertebral route of administration. Dependent chest tube bupivacaine losses were approximately four times higher in the interpleural group.


CONCLUSIONS
Local anesthetic on the diaphragm might actively impair respiratory function through diaphragmatic and abdominal muscle weakness, while failing to contribute to pain relief.
Richardson
J
J
Department of Anesthetics, Bradford Royal Infirmary, England.
Sabanathan
S
S
Shah
R D
RD
Clarke
B J
BJ
Cheema
S
S
Mearns
A J
AJ
D000368:Aged; D016058:Analgesia, Patient-Controlled; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008168:Lung / Q000187:drug effects* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D010994:Pleura; D011184:Postoperative Period; D011446:Prospective Studies; D013131:Spine; D013908:Thoracotomy
D000779:Anesthetics, Local; D009020:Morphine; D002045:Bupivacaine