Analgesic effects of interpleural bupivacaine with fentanyl for post-thoracotomy pain

Abstract

Objective: The analgesic effect of bupivacaine/fentanyl with epinephrine given interpleurally after thoracotomy was investigated in a randomized placebo and intravenous controlled study. Design: Prospective clinical study. Setting: University teaching hospital. Participants: Sixty American Society of Anesthesiologists physical status II and III patients scheduled for posterolateral thoracotomy with general anesthesia. Interventions: Patients were randomly divided into 4 groups to receive either 0.5% bupivacaine/1.5 mug/kg of fentanyl with 5 mug/mL of epinephrine (n = 15, group IPBF), 0.5% bupivacaine with 5 mug/mL of epinephrine (n = 15, group IPB), or saline (n = 15, group IPS) in a total volume of 15 to 20 mL in 60 seconds by an interpleural catheter placed at the end of surgery by direct vision. The same volume of bupivacaine 0.25% and 1.5 mug/kg of fentanyl with 5 mug/mL of epinephrine to group IPBF, bupivacaine 0.25% with 5 mug/mL of epinephrine to group IPB or saline to group IPS was injected through the interpleural catheter every 6 hours for 48 hours postoperatively. Intravenous fentanyl (n = 15, group IVF) and interpleural saline groups received 1.5 mug/kg of fentanyl intravenously at the first complaint of pain. All patients also received patient-controlled analgesia (PCA) with fentanyl for 48 hours postoperatively. Metamizol sodium was used as a rescue analgesic. Measurements and Main Results: Adequacy of pain relief was evaluated with the "Prince Henry Pain Scale" and visual analog pain scale. Fentanyl consumption via PCA and complications were evaluated for 48 hours. Visual analog scale scores were significantly higher in the interpleural saline group at 4 and 12 hours (6.6 +/- 1.2 and 5.0 +/- 2.1, respectively) postoperatively. Significantly more patients in the IPBF group had lower pain scores during coughing and deep breathing. Fentanyl consumption via PCA device was significantly higher in the intravenous fentanyl group (1,069 +/- 96.9 mug) than the interpleural groups (577.3 +/- 72.2 mug, 651.1 +/- 61.9 mug, and 601.0 +/- 22.6 mug in IPBF, IPB, and IPS groups, respectively). Conclusion: It is concluded that total fentanyl consumption via PCA decreased in all interpleural groups, but pain during coughing and deep breathing was significantly reduced in only the interpleural bupivacaine/fentanyl with epinephrine group. mu 2004 Elsevier Inc. All rights reserved.