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Continuous Pleural Infusion of Bupivacaine Offers Better Postoperative Pain Relief than Does Bolus Administration
  1. Jose Luis Aguilar, M.D., PH.D., DEAA*,**,
  2. Antonio Montero, M.D., PH.D.*,**,
  3. Jaime F-Llamazares, M.D., PH.D.§,
  4. Antonio Montes, M.D.*,,
  5. Fernando Vidal, M.D.*, and
  6. Cruz Pastor, PH.D.#,
  1. Presented in part at the annual meeting of the European Society of Regional Anesthesia, Bern, September 1990.
  2. *From Servicio de Anestesiologia, Reanimacion y Terapeutica del Dolor.,
  3. §Servicio de Cirugia General, and
  4. #Servicio de Bioquimica, Hospital Universitario de Badalona Germans Trias I Pujol, Universidad Autonoma de Barcelona, Badalona, Barcelona, Spain.
  5. **Senior Registrar, Anesthesia Department.
  6. Resident, Anesthesia Department.
  7. Chairman, Anesthesia Department.
  8. Professor of Surgery, Universidad Autónoma de Barcelona; Senior Registrar, Surgery Department.
  9. Staff, Biochemistry Department.
  1. Address correspondence and reprint requests to Jose Luis Aguilar, M.D., Ph.D., DEAA, Clínica del Dolor., Servicio de Anestesiología, Hospital Universitario de Badalona, Aptdo. Correos 72, 08916 Badalona, Barcelona, Spain.


Background and Objectives. To determine whether continuous pleural analgesia offers better postoperative pain relief than does bolus administration in postcholecystectomy patients.

Methods. Eighty postcholecystectomy patients with a subcostal incision were randomly allocated to receive pleural analgesia with either a bolus regime of 20 ml 0.375% bupivacaine with 1:200,000 epinephrine at four-hour intervals (bolus group), or a loading dose of 20 ml 0.375% bupivacaine with 1:200,000 epinephrine immediately followed by a continuous infusion at a rate of 6 ml/hour during the first 24 hours postoperatively (infusion group). A 10-cm linear visual analog scale was used and recorded before performing pleural analgesia and at 1, 6, 12, 18, and 24 hours subsequently. Plasma levels of bupivacaine were determined in eight patients of the infusion group. Samples were taken at 5, 15, 30, and 60 minutes and at 6 and 18 hours after the start of infusion.

Results. Mean visual analog scale values were significantly lower ( p < 0.001) at 6, 12, 18, and 24 hours in the infusion group. PaCO2 decreased significantly ( p <0.001) after the block in both groups, with no difference between the groups. Plasma levels were well below toxic levels in the infusion group.

Conclusions. Continuous pleural analgesia offers better postoperative pain relief than does bolus administration. Pneumothorax was observed in two patients during the study.

  • Anesthetic techniques
  • pleural
  • anesthetics
  • local
  • bupivacaine
  • pain
  • postoperative.

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  • Supported in part by a grant from the Fondo de Investigaciones Sanitarias de la Seguridad Social, Ministerio de Sanidad y Consumo de España.

    The authors thank Dr. Valentín Mazo for his statistical advice and Mrs. Assumpció Plana, Mrs. Francisca Rueda, and Mrs. Francisca Rodriguez-Vilchez for their technical collaboration.