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Ann Thorac Surg 1992;53:449-454
© 1992 The Society of Thoracic Surgeons

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Articles

Intrapleural bupivacaine in the control of postthoracotomy pain

^a Departments of Surgery and Physiotherapy, Repatriation General Hospital, Concord, New South Wales, Australia
^b National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia

Accepted for publication August 23, 1991.

^_* Address reprint requests to Dr Mann, Department of Surgery, Clinical Sciences Building, Repatriation General Hospital, Concord, NSW 2139, Australia.

A randomized, double-blind trial was conducted to determine the effectiveness of intrapleural bupivacaine hydrochloride in the management of pain after thoracotomy. Thirty-three men and 7 women with a mean age of 62 years (range, 21 to 76 years) undergoing elective posterolateral thoracotomy were randomly allocated preoperatively to either a study group receiving 20 mL of 0.25% bupivacaine or a control group receiving 20 mL of 0.9% saline solution through a pleural catheter every 4 hours. Patients received supplementary doses of intramuscular papaveretum as required. Assessment of pain, somnolence, and breathing capacity was performed after the intrapleural injections at 4, 24, 48, and 72 hours postoperatively. Pain assessment, as measured by a linear analog scale, was lower in the bupivacaine group at all times, reaching significance at 4, 24, and 72 hours (p < 0.05). The forced vital capacity and forced expiratory volume in 1 second at 6 weeks postoperatively remained significantly lower than preoperatively (p < 0.05). The fall in forced vital capacity from this postoperative level was significantly less in the bupivacaine group at 4, 24, and 48 hours, and the fall in forced expiratory volume in 1 second was significantly less at 4 and 48 hours in the treated group. When used in conjunction with doses of parenteral narcotic, intrapleural bupivacaine gives better pain control with less respiratory depression than intermittent doses of narcotic alone.

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