Pain control after percutaneous biliary drainage: local infiltration with bupivacaine and epinephrine

Pain Control for Percutaneous Biliary Procedures

“…5 The efficacy of the technique appears to be largely related to blockade of the somatic component of pain mediated by the intercostal nerves. 1,6,7 The procedure is simple, safe, and very effective.…”

“…Bupivacaine has the longest duration of action of all Associate Professor of Clinical Radiology and Chief of Angiography and Interventional Radiology, Department of Diagnostic Radiology Northwestern University Medical School and Northwestern Memorial Hospital, Chicago, Illinois local anesthetics; the addition of epinephrine prolongs the effects of the drug. 1,7 After selection of the catheter or needle entry site, nerve blocks are performed on the rib immediately superior to the punctured interspace, as well as one rib above and below the site, because there can be some sensory overlap of these nerves. The ribs are palpated, and the skin is punctured with a 25-gauge needle attached to an anesthetic-filled syringe.…”

“…The largest component of this pain is probably related to catheter irritation of the parietal pleura or diaphragm and is mediated by intercostal somatic nerves. 1 The consequences of such pain are substantial and include diaphragmatic splinting and respiratory embarrassment; these prolems are often accompanied by chest roentgenographic abnormalities such as diaphragmatic elevation, pleural effusion, pulmonary infiltrates, and atelectasis, which we have observed in as many as 40% of patients undergoing this procedure. [2][3][4] There are additional hazards associated with severe pain: bedridden patients immobilized by pain are at risk for deep venous thrombosis, appetite is depressed, and the large narcotic doses needed to overcome the pain may impair mental status and dull swallowing and gagging mechanisms, particularly in the elderly.…”

Percutaneous Biliary Drainage with Emphasis on Hilar Lesions

“…Some skin and abdominal wall discomfort is common and may in some patients require nerve block or local anesthesia for relief (81 ).…”