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Intrapleural bupivacaine--technical considerations and intraoperative use
T Symreng1, M N Gomez, B Johnson
1Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City 52242.
Journal of Cardiothoracic Anesthesia
|April 1, 1989
Summary
Blind insertion of intrapleural catheters poses risks, including lung penetration and pneumothorax. Intrapleural bupivacaine did not enhance anesthesia during thoracotomies, with lung placement delaying drug absorption and increasing toxicity risk.
Area of Science:
- Anesthesiology
- Thoracic Surgery
- Pharmacology
Background:
- Blind insertion of intrapleural catheters is a common technique.
- Concerns exist regarding the safety and efficacy of intrapleural catheterization and drug administration.
Purpose of the Study:
- To evaluate technical problems associated with blind intrapleural catheter insertion.
- To assess the pharmacokinetic and analgesic effects of intrapleural bupivacaine compared to saline.
Main Methods:
- 21 anesthetized patients underwent blind intrapleural catheter insertion.
- Catheters were injected with bupivacaine or saline in a double-blind manner.
- Catheter position and lung integrity were assessed after chest opening.
Main Results:
- Catheter misplacement occurred frequently (intrapleural, extrapleural, or in lung tissue).
- Lung perforation and pneumothorax (including tension) were observed.
- Lung penetration delayed peak plasma bupivacaine levels and risked toxicity; no analgesic benefit was found.
Conclusions:
- Blind intrapleural catheter insertion is hazardous, particularly with positive-pressure ventilation.
- Catheter malposition in lung tissue can lead to delayed drug absorption and potential toxicity.
- Intrapleural bupivacaine is not a beneficial adjunct for general anesthesia during thoracotomies.