Abstract

The intrapleural administration of bupivacaine for pain relief was evaluated in patients with multiple rib fractures. In six patients an intermittent dosage technique was used. An intrapleural catheter was inserted and 20 ml of 0.5% bupivacaine was administered every 8 hours for 2-3 days and every 12 hours for an additional 3-4 days. Adequate pain relief was achieved in all patients in this group. In addition, the mean Paco₂ decreased significantly from 59.5 ± 1.5 mm, Hg before local anesthetic therapy to 37.4 ± 2.0 mm Hg after intrapleural administration of bupivacaine. In a second group of three patients, an initial intrapleural injection of 20 ml of 0.5% bupivacaine was followed by continuous infusion of 0.25 or 0.5% bupivacaine at a rate of 5-10 ml/hour. Infusion was continued for 5-10 days and provided excellent pain relief. Peak mean venous blood levels of bupivacaine varied from 1.1-2.38 μg/ml in these patients. The continuous infusion of 0.5% bupivacaine produced unilateral anesthesia to pinprick from T2-T10, whereas the 0.25% bupivacaine solution produced pain relief without a discernible level to pinprick. Intercostal or abdominal muscle paresis was not noted in any of the nine patients. Intrapleural administration of bupivacaine appears to be an effective means of providing pain relief for patients with multiple rib iractures. Further studies appear warranted to determine the optimal use of this new technique in such patients.