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Interpleural analgesia for post thoracotomy pain
S138 INTERPLEURALANALGESIAFOR POST THORACOTOMYPAIN. K.Yamamoto,W.Z.Li+, and S.Murakami, Departmentof Anesthesiology, Kanazawa University, Kanazawa, Japan AIM OF INVESTIGATION: The feasibilityof interpleuralanalgesia (IPA) for post thoracotomypain is controversial. This study evaluatedthe iAbS dynamics and kinetics of IPA in thoracotomy. METHODS: Thirteen adult patients who underwent thoracotomy for various lung surgery consented to IPA. A 16G epidural catheter was inserted into the pleural cavity by the method of Reiestad et al. The catheterwas insertedthe day before the surgery to estimate the sensory block produced by IPA in six patients. When the patient reported pain after the surgery, 20 ml of 0.5% plain bupivacainewas injected in head down position.The chest tubes were clamped for 15 minutes. In case of poor analgesia,butorphanol2.0 mg was given intramuscularly. Arterial blood was sampled at frequent intervals to estimate serum bupivacaine. The amount of bupivacaine cumulated in chest drainage was measured at 60 minutes after the injection. Bupivacainewas estimatedby HPLC. RESULTS: The level of sensory block was two to three segmentsof ipsilateralintercostal nerve in most cases. Three patients out of thirteen could be managed without butorphsnol postoperatively. Bupivacaineconcentrationin arterial serum showed a wide interindividual variationwith Cmax and Tmax 1.13 + 0.25 mcg/ml and 19.4 + 5.0 minutes, respectively. The amount of bupivacainecumulated in chest drainage at 60 minutes accountedonly 14.0 % of the injecteddose (Table). CONCLUSION: Interpleuralanalgesiawith 0.5 % bupivacainewould not be feasible for post thoracotomypain relief. The loss of bupivacaineinto the chest drainage could not be the principalfactor for the insufficientanalgesiceffect. (TAM=) time mean SEM
BUPIVACAINEIN SERUM (n=S) 10 15 30 45 60 SO 120 0.72 0.97 0.98 0.95 0.91 0.85 0.77 0.34 0.17 0.22 0.28 0.25 0.32 0.33
min mcg/ml
IN CHEST DRAINAGE (n=S) 60 min 14.0 mg 3.5
SYSTEMICPIROXICAMAS AN ADJUNCT TO COMBINED EPIDURAL BUPIVACAINEAND MORPHINE FOR POSTOPERATIVEPAIN - A DOUBLE BLIND STUDY. 1 T.Mogensfn,MD , P. "egger,3MDl, T. Jonsson, MD', AE Ma1zke, MD2, C. Lund, MD , H.Keh et, MD,PhD . Departments of anesthesia and surgical h
Poster 228 BLUE Mon-Tues Exhibit Hall
Abs No 271 gastroenterology ,Herley University Hospital and surgical gastroentero!1 logy, Hvidovre Hospital , DK-2130 Herlev, Denmark. AIM OF INVESTIGATION: To evaluate the effect of an additional peripheral analgesic agent (NSAID, piroxicam) to a continuous low dose epidural infusion of opioid and local anaesthetic on postoperative pain. METHODS: 44 patients (mean age 51 yr) scheduled for major upper abdominal surgery during combined general anaesthesia and thoracic epidural analgesia (T 7-8)with bupivacaine o,5% 9 ml. Postoperative epidural analgesic treatment was bupivacaine 0~25%~ 4 ml/h plus morphine 0.2 mg/h for 72 h.The patients were randomized double blind to 40 mg piroxicam rectally 12 h before surgery and 20 mg piroxicam rectally every 24 h for 72 h (group I) or placebo suppositories (group II). Pain was evaluated at rest, during cough and mobilisation in bed at 4 h intervals by VAS and verbal rate scoring. Sensory analgesia was evaluated by pin-prick. RESULTS: Both regimens provided excellent pain relief. Mean VAS during 72 h at rest was 0.4 and o.5,during cough 2.7 and 2.9, and during mobilization 2.8 and 2.3 (p > 0.05) (group I and II, respectively). Mean verbal rate was at rest 0.3 and 0.4, during cough 1.3 and 1.3 and at mobilization 1.1 and 1.1 (p > 0.05) (group I and II). Mean supplemental i.m. morphine during the 72 h was 16.3 and 14.6 mg (p > 0.05). (group I and II). Mean sensory analgesia decreased (p > 0.05) from T 3.4 preoperatively to T 5.5 72 h postoperatively. 4 patients were excluded due to technical problems. No respiratory or bleeding complications were seen. CONCLUSION: The results of this double blind study'failed to show an enhanced analgesic effect of supplementary piroxicam to a low dose epidural bupivacaine regimen after major upper abdominal surgery.
BUPIVACAINEIN SERUM (n=S) 10 15 30 45 60 SO 120 0.72 0.97 0.98 0.95 0.91 0.85 0.77 0.34 0.17 0.22 0.28 0.25 0.32 0.33
min mcg/ml
IN CHEST DRAINAGE (n=S) 60 min 14.0 mg 3.5
SYSTEMICPIROXICAMAS AN ADJUNCT TO COMBINED EPIDURAL BUPIVACAINEAND MORPHINE FOR POSTOPERATIVEPAIN - A DOUBLE BLIND STUDY. 1 T.Mogensfn,MD , P. "egger,3MDl, T. Jonsson, MD', AE Ma1zke, MD2, C. Lund, MD , H.Keh et, MD,PhD . Departments of anesthesia and surgical h
Poster 228 BLUE Mon-Tues Exhibit Hall
Abs No 271 gastroenterology ,Herley University Hospital and surgical gastroentero!1 logy, Hvidovre Hospital , DK-2130 Herlev, Denmark. AIM OF INVESTIGATION: To evaluate the effect of an additional peripheral analgesic agent (NSAID, piroxicam) to a continuous low dose epidural infusion of opioid and local anaesthetic on postoperative pain. METHODS: 44 patients (mean age 51 yr) scheduled for major upper abdominal surgery during combined general anaesthesia and thoracic epidural analgesia (T 7-8)with bupivacaine o,5% 9 ml. Postoperative epidural analgesic treatment was bupivacaine 0~25%~ 4 ml/h plus morphine 0.2 mg/h for 72 h.The patients were randomized double blind to 40 mg piroxicam rectally 12 h before surgery and 20 mg piroxicam rectally every 24 h for 72 h (group I) or placebo suppositories (group II). Pain was evaluated at rest, during cough and mobilisation in bed at 4 h intervals by VAS and verbal rate scoring. Sensory analgesia was evaluated by pin-prick. RESULTS: Both regimens provided excellent pain relief. Mean VAS during 72 h at rest was 0.4 and o.5,during cough 2.7 and 2.9, and during mobilization 2.8 and 2.3 (p > 0.05) (group I and II, respectively). Mean verbal rate was at rest 0.3 and 0.4, during cough 1.3 and 1.3 and at mobilization 1.1 and 1.1 (p > 0.05) (group I and II). Mean supplemental i.m. morphine during the 72 h was 16.3 and 14.6 mg (p > 0.05). (group I and II). Mean sensory analgesia decreased (p > 0.05) from T 3.4 preoperatively to T 5.5 72 h postoperatively. 4 patients were excluded due to technical problems. No respiratory or bleeding complications were seen. CONCLUSION: The results of this double blind study'failed to show an enhanced analgesic effect of supplementary piroxicam to a low dose epidural bupivacaine regimen after major upper abdominal surgery.