Intrapleural bupivicaine in latissimus dorsi breast reconstruction

The use of intrapleural (IP) analgesia for controlling post-operative pain in breast reconstruction is not well documented. The objective of this study was to assess the value of IP bupivacaine in those patients undergoing latissimus dorsi breast reconstruction. Twenty-six patients received a single bupivacaine IP injection at induction of anesthesia. Eighteen of these patients also received a 24-hour postoperative IP infusion. A control group of 22 patients did not receive an IP block. All patients had access to morphine via patient-controlled analgesia pumps. The 24-hour morphine requirements were recorded for each group and the data were analyzed by Student t test. Significance was taken at the 5% level. The mean morphine requirement in the control group was 39.2 mg +/- 2.89 mg. This was significantly greater than the requirement of the 8 patients who had a single IP injection of bupivacaine at induction (10.1 mg +/- 2.76 mg), P < 0.001. It was also significantly greater than that of the 18 patients who received an IP infusion (2.7 mg +/- 1.35 mg), P < 0.0001. The infusion group required significantly less morphine than the single injection group did, P < 0.02. No complications following IP injection were noted in this series. Intrapleural analgesia is a safe technique and significantly reduces the requirement for postoperative opiate analgesia in those undergoing latissimus dorsi breast reconstruction.