Journal of Torbat Heydariyeh University of Medical Sciences

Background:  The  management   of   post-thoracotmy    pain   is  an important issue and  may  lead   to  atelectasis,   hypoxemia,  pulmonary  infection,  and  permanent   alveolar  damage.  The  purpose  of  the  present  study  was  to  investigate  the  efficacy  of  Interpleurl Regional (IP) analgesia  with  Bupivacaine  after  thoracotomy  for  pain  control .

Material   and   methods:  Thirty   patients   undergoing   elective   posterolateral   thoracotomy   were   included   in a   prospective   randomized, double   blinded trial.  Patients   were   divided to equal groups and each group assigned   to   receive   either 0.5% bupivacaine   or saline solution   interpleurally   every   4h   for 24h postoperatively.  All   patients   also   received   patient-controlled   analgesics (PCA) with 1mg morphine   every 5 minutes   for   additional   pain control.  Pain   was  measured  on  the  basis  of  PCA  requirements   and  by  using  a  Visual   Analog Scale (VAS).

Findings:   Visual  Analog  Scale  scores  and  PCA  requirements  Were the same for both  groups .  Both   interpleural   bupivacaine   and   saline significantly reduced pain scores   after the   administration. It seems   pain   reduction   by interpleural   instillation   of   bupivacaine   is the result of the   placebo-like   effects   however interpleural regional analgesia   is not   effective   in patients   undergoing   lateral thoracotomy.  Sex and BMI were   shown   to influence   postoperative   pain intensity.  The   female   patients, and   those   with   higher body mass, reported higher   pain   scores.  This   observation   appears   to be of only marginal clinical significance.

Conclusion:  The efficacy of Interpleural Regional   Analgesia to reduce postoperative pain intensity   in   patients   after   thoracotomy   is controversial. The present study demonstrates   a lack of efficacy of interpleural regional analgesia.