[Hemodynamic repercussion of epidural bupivacaine in thoracic injuries]

Systemic and pulmonary hemodynamic effects of 8 to 10 ml of 0.25% bupivacaine containing 1:200,000 adrenaline administered at the midthoracic level were prospectively assessed in 20 patients (aged 45 +/- 16 years) with thoracic trauma presenting 6 +/- 2 rib fractures and pulmonary contusion of different extent and radiologic density. The study was carried out at comparable evolving times, 24 h after trauma, during the second or third day of treatment, and when the hemodynamic stability of the patient was achieved. Hemodynamic measurements were performed before and 30 min after administration of the analgesic agent using a Swan-Ganz catheter. The results indicate that administration of moderate doses of epidural bupivacaine at the middle thoracic level in patients with normovolemic thoracic traumatism were not followed by alterations in the hemodynamic function except for a slight decrease in systemic arterial and pulmonary pressure. The mean arterial pressure decreased by 8% (p less than 0.05), the cardiac index showed a 4% reduction (p = 0.05), and the mean pulmonary pressure experienced a 14% decrease (p less than 0.05).