Key result
Interpleural bupivacaine after esophagectomy significantly reduced total morphine consumption compared to placebo (41.2 vs 66.1 mg; P<0.02), whereas lidocaine was ineffective.
Why the study?
Does interpleural administration of bupivacaine or lidocaine reduce pain and morphine requirement in patients after esophagectomy with thoracotomy?
RCT
Does interpleural administration of bupivacaine or lidocaine reduce pain and morphine requirement in patients after esophagectomy with thoracotomy?
Absolute Event Rate: 41.2% vs 66.1%
p-value: p=<0.02
Interpleural bupivacaine, but not lidocaine, reduces thoracic pain and morphine requirements after esophagectomy, though supplemental PCA morphine remains necessary for adequate analgesia.
May support adjunctive interpleural bupivacaine post-esophagectomy; hypothesis-generating and requires validation in larger trials before practice change.
The purpose of the present study was to investigate the efficacy of interpleural (IP) analgesia with bupivacaine or lidocaine after esophageal surgery and to measure the plasma concentrations of bupivacaine and lidocaine after intermittent IP administrations.Two IP catheters were inserted percutaneously in the seventh intercostal space during operation. Patients in the bupivacaine group (Gr B) received 1 mg/kg of 0.5% bupivacaine with epinephrine 1:200000 in 20 mL of saline 0.9%, patients in the lidocaine group (Gr L) received 3 mg/kg of 2% lidocaine with epinephrine in 20 mL of saline 0.9%, and patients in the placebo group (Gr P) received 20 mL of saline 0.9% every 4 h during 2 days. Pain was assessed by visual analog scale (VAS) every 4 h at rest (VASR), after a deep breath or cough (VASC), at the thoracotomy (VAST), and at the laparotomy (VASL). Morphine consumption using a patient-controlled analgesia (PCA) device was recorded. There was no significant difference in the mean VASR, VASC, and VASL scores among the three groups. VAST scores were significantly lower in Gr B at 12, 16, 28, and 32 h when compared with Gr P and Gr L (P < 0.05). There was no statistical difference in mean VAST between Gr L and Gr P. Total consumption of morphine was lower in Gr B than in Gr P and Gr L (41.2 +/- 13 mg vs 66.1 +/- 21 mg in Gr P (P < 0.02) and 75.5 +/- 27 mg in Gr L (P < 0.01)), but were similar in Gr L when compared with Gr P. No patient had any symptoms suggestive of local anesthetic toxicity despite high peak plasma concentration (maximum 5.48 micro gram/mL and 3.91 micro gram/mL for lidocaine and bupivacaine respectively). We conclude that 1) IP analgesia with bupivacaine after esophagectomy reduced morphine requirements due to a decrease in the thoracic pain in comparison to a placebo; 2) IP analgesia with lidocaine was ineffective; and 3) if VAS values in the range 0-3 cm represent adequate analgesia, morphine administration by PCA was not sufficient even in association with bupivacaine IP analgesia. (Anesth Analg 1995;80:718-23)
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François et al. (1995) conducted an RCT in Pain after esophagectomy with thoracotomy. Interpleural bupivacaine or lidocaine vs. Placebo (saline 0.9%) was evaluated on Total consumption of morphine (p=<0.02). Interpleural bupivacaine after esophagectomy significantly reduced total morphine consumption compared to placebo (41.2 vs 66.1 mg; P<0.02), whereas lidocaine was ineffective.
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