Percutaneous biliary drainage: clinical trial of analgesia with interpleural block.

Abstract

Interpleural block was effective in decreasing pain and opioid requirements during and after percutaneous biliary drainage and did not compromise the cardiopulmonary status of the patient. However, the rate of pneumothorax was higher than previously reported.

Interpleural block – part 2

“…Two case series have confirmed the safety and efficacy with lack of haemodynamic and respiratory adverse effects of interpleural block for pain relief for percutaneous hepatobiliary drainage [27,28]. In a double-blind, placebo controlled trial, Therasse et al [29] performed biliary drainage after an interpleural block with bupivacaine 0.5% with adrenaline 30 ml. Fentanyl patient-controlled analgesia was available to both the block and the placebo groups.…”

“…Tumour invasion of the brachial plexus [68] Unilateral breast surgery [1,12,15,16] Open cholecystectomy [1][2][3][4][5][6][7][8][9][10][11] Pain of acute herpes zoster and post herpetic neuralgia [64][65][66][67] Needle localisation and breast biopsysole anaesthetic [15] Laparoscopic cholecystectomy [25,26] Chronic regional pain syndromes of the upper limb [36,61,63] Thoracotomy [42,43,45,[48][49][50][51] Renal surgery [1,[12][13][14] Upper limb ischaemia [62] Chest drain [108,109] Abdominal surgery (bilateral blocks) [55,56] Cardiac surgery [53,54] Percutaneous hepatic and biliary drainage procedures [27][28][29] Thoracic sympathectomy…”

“…In a double‐blind, placebo controlled trial, Therasse et al. [29] performed biliary drainage after an interpleural block with bupivacaine 0.5% with adrenaline 30 ml. Fentanyl patient‐controlled analgesia was available to both the block and the placebo groups.…”

Trunk blocks for abdominal surgery

“…2). It has been shown to be an effective method of achieving analgesia for subcostal and flank incisions [16–18]. A recent review of 11 studies that used intrapleural catheters for analgesia after open cholecystectomy demonstrated significant decreases in pain and opioid requirements [19].…”

“…It has been suggested that the reason for failure of reliable analgesia from intrapleural block is surgical interruption of the continuum of the pleura or the loss of LA solution through chest drains. Furthermore, this technique has been shown to be associated with an increased risk of pneumothorax [18]. The most recognised complications of intercostal blocks include rapid systemic uptake or haemopneumothorax.…”