The Association of Interpleural Ropivacaine and Epidural Following Major Thoracic Surgery: A Randomised Clinical Trial Investigating Pharmocokinetics and Benefits

Background: Thoracic surgery is associated with high levels of postoperative pain. Interpleural blockades (IPB) can be effective in reducing this pain, but results after thoracotomy are controversial. The current study investigates the effects of the association of ropivacaine-based IPB and morphine epidurals after posterolateral thoracic surgery. Research Article British Journal of Medicine & Medical Research, 3(4): 841-854., 2013 842 Method: In this prospective, randomised, triple blind, placebo-controlled trial, patients received either intermittent ropivacaine IPB (R-group), (30 mg every 6 hours over 48 hours) or a placebo containing saline serum (P-group). The two groups had a morphine lumbar epidural. Pain was evaluated via patients’ reports and total morphine requirements. Results: 90 patients participated. There were no significant differences between levels of pain reported on mobilisation or morphine consumption between the two groups. For the principal criterion of VAS-A≥70 over the first 48 hours, this corresponds to a RR of 1.3(95%= 0.4-3.8). Patients in the R-group reported higher levels of pain at rest on day 2. The mean peak plasma concentrations of ropivacaine remained inferior to toxic plasma concentration levels. Conclusion: Postoperative interpleural infusions of 30 mg of ropivacaine every 6 hours in association with morphine epidurals are safe and feasible but do not improve postoperative experience of pain.