Post‐operative local analgesia for thoracotomy with direct bupivacaine intercostal blocks*

Abstract

Clinica I for1111 I 56 1 vision; the extent of any oedema and its position can then be seen and infected material can be easily removed by suction from the oro-pharynx, where it tends to pool in a patient in the Trendelenburg position. There is a theoretical risk that a nasal tube on its way through the pharynx might rupture the abscess. Some anaesthetists have used oral tubes to obviate this risk, but it does not seem to be a problem in practice and the risk can be reduced if the nostril on the opposite side from the quinsy is used for the naso-tracheal tube when possible.Suxamethonium may be used with safety to faciliatate intubation if it is first ascertained that it is possible to inflate the patient manually.There are degrees of severity of quinsies and the individual anaesthetist must decide which is the most suitable method of induction for a particular patient in his hands but, in spite of the fact that forty-three patients were induced with a barbiturate and suxamethonium for intubation without complication in the present series, this should not be regarded as the method of choice. SutntnaryA review is presented of 114 cases of quinsy tonsillectomy. This shows that this advantageous operation has a low complication rate and is safe in skilled anaesthetic hands. AcknowledgmentsThe author wishes to thank Dr Derek Wylie for his constructive criticism and the surgeons of the Ear, Nose and Throat Department of St Thomas' Hospital for their co-operation. Re ferences

Effect of intercostal nerve blockade during operation on lung function and the relief of pain following thoracotomy

“…We were surprised to find no difference in the degree of impairment of vital capacity and peak expiratory flow rate after operation between groups of patients who had or had not removal of lung tissue. The decrease in VC and PEFR was very similar to that found by other investigators (Bergh et al, 1966;Jorgensen, 1967;Tammisto and Sivula, 1967;Delilkan et al, 1973) in similar conditions. However, the present work did not show the improvement from the use of local anaesthetic agents reported by Dottori and colleagues (1964), Bergh and colleagues (1966) and Delilkan and others (1973).…”

A prospective, randomised comparison of continuous paravertebral block and continuous intercostal nerve block for post-thoracotomy pain

“…A single intercostal injection of local anesthetic can provide analgesia for up to 6 hours. 24 To achieve longer duration of analgesia and to obtain multiple dermatomes analgesia, a continuous extrapleural intercostal nerve block has been developed by Sabanathan. 9 In our study, it was possible to insert the catheter in all the cases except in one patient who had kyphoscoliosis.…”

Continuous Extrapleural Intercostal Nerve Block With Continuous Infusion of Lidocaine After Thoracotomy

“…Eigh¬ teen consecutive posterolateral thoracotomies (in 17 patients) performed during a 6-month period were reviewed. Serum lidocaine exceeded the toxic level of 5 ug/mL in only one patient, a 104.5-kg man who had a level of 5.9 ug/mL on postoperative day 2 but expe¬ rienced no clinical toxicity. Pain was evaluated by verbal analog scores (0=no pain and 10=worst pain), which averaged 3.02, 3.14, and 2.8 in the 3 days following surgery.…”