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Ann Thorac Surg 1999;67:828-829
© 1999 The Society of Thoracic Surgeons

Commentary

Jeffrey A. Grass, MDa

a Division of Anesthesiology, The Cleveland Clinic Foundation, 9500 Euclid Ave/E-31, Cleveland, OH 44195, USA

Invited commentary

Watson and colleagues present a scientifically well-conducted, randomized, double-blind clinical investigation that demonstrates that lidocaine offers pain relief equivalent to bupivacaine when administered for continuous extrapleural intercostal nerve blockade after thoracotomy. Although they did not assess or compare a dose-response range for either local anesthetic, the doses used for each drug (bupivacaine, 0.5 mg · kg-1 · h-1; lidocaine, 1 mg · kg-1 · h-1) are well-established in the literature for continuous extrapleural intercostal nerve blockade. These doses proved to be equianalgesic in this study, producing similar pain scores with equal supplemental opioid requirements.

Even though systemic toxicity did not occur in any of the limited number of patients in this study, the authors’ concern about the potential for systemic toxicity with bupivacaine for this continuous nerve blockade technique is well taken and cannot be emphasized enough. Whichever local anesthetic drug is selected, it must be noted that intercostal nerve blockade results in the highest plasma concentrations of local anesthetic of all commonly used . . . [Full Text of this Article]


Related Article

Pain control after thoracotomy: bupivacaine versus lidocaine in continuous extrapleural intercostal nerve blockade
Derek S. Watson, Steve Panian, Vaughan Kendall, D. Patrick Maher, and George Peters
Ann. Thorac. Surg. 1999 67: 825-828. [Abstract] [Full Text] [PDF]





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