Blood-stained pleural effusion complicating interpleural analgesia

A case of blood-stained pleural effusion complicating interpleural analgesia for a difficult nephrectomy is reported. We describe our technique of placement of the interpleural catheter. Interpleural infusion of 0.25% bupivacaine at 7 mls/h provided excellent postoperative analgesia. However, a left pleural effusion was demonstrated from chest X-ray films taken from the third day post-operatively. Persistent low grade fever and a large pleural effusion necessitated drainage which resulted in improvement in symptoms. Possible aetiologies of the effusion are discussed, although the exact cause was uncertain. Observation for a developing pleural effusion and other complications should form part of the postoperative observation and if one does develop, the necessary measures can be taken.