Intrapleural analgesia following thoracoscopic sympathectomy for palmar hyperhidrosis: a prospective, randomized trial.
BACKGROUND
Reports on intrapleural analgesia (IPA) are conflicting. The current study assessed the effect of a single-dose thoracoscopic bilateral intrapleural anesthetic administration on the immediate postoperative recovery room and 24-h pain control.


METHODS
Fifty patients with primary palmar hyperhidrosis were randomly classified into two groups to receive either 20 ml of 0.5% bupivacaine and 5 mg/ml epinephrine or 0.9% NaCl in each thoracic cavity at the end of thoracoscopic T2-T3 sympathectomy. The degree of early postoperative pain was estimated by visual analog scale (VAS). The 24-h parenteral opioid analgesic requirement was recorded.


RESULTS
The immediate postoperative VAS score (1.46 +/- 0.41 vs 2.0 +/- 0.61, p = 0.03), opioid consumption (0.42 +/- 0.36 vs 0.65 +/- 0.28, p = 0.0133), and 24-h opioid consumption (1.02 +/- 0.80 vs 1.48 +/- 0.84, p = 0.05) were significantly reduced following IPA compared to those of the control group.


CONCLUSIONS
IPA is a simple and effective means for postoperative pain control following thoracoscopic upper dorsal sympathectomy.
Assalia
A
A
Department of Surgery B, Rambam Medical Center, Haifa, Israel.
Kopelman
D
D
Markovits
R
R
Hashmonai
M
M
D000328:Adult; D000698:Analgesia / Q000379:methods*; D000768:Anesthesia, General / Q000379:methods; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006945:Hyperhidrosis / Q000601:surgery*; D015552:Injections, Intralesional / Q000379:methods; D008297:Male; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000473:pathology / Q000517:prevention & control; D011446:Prospective Studies; D013562:Sympathectomy / Q000379:methods*; D035423:Thoracic Cavity / Q000378:metabolism* / Q000601:surgery; D013906:Thoracoscopy / Q000379:methods*
D002045:Bupivacaine; D004837:Epinephrine