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REGIONAL ANESTHESIA

A Spray Catheter Technique for Pleural Anesthesia: A Novel Method for Pain Control Before Talc Poudrage

Pyng Lee, MD^*, and Henri G. Colt, MD, FCCP

From the *Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore; and Department of Pulmonary and Critical Care Medicine, University of California, Irvine Medical Center, Irvine, California.

Address correspondence and reprint requests to Pyng Lee, MD, Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Outram Road, Singapore 169608. Address e-mail to lee.pyng{at}sgh.com.sg.

BACKGROUND: Chemical pleurodesis causes severe pain, prompting physicians to perform thoracoscopic talc poudrage under general or neuroleptanalgesia. We describe a novel method for pain control in five patients with pneumothoraces and severe chronic obstructive pulmonary disease.

METHODS: Patients were premedicated with IM pethidine and IV midazolam. The pleural space was examined with the flex-rigid pleuroscope. Before talc poudrage, 250 mg lidocaine was administered via spray catheter, and pain scores measured immediately after the procedure and on postoperative days 1 and 2 were 3, 2, and 2, respectively.

RESULTS: No complications were noted, and 30-day mortality was 0%.

CONCLUSION: Lidocaine via spray catheter is effective for pain control before pleurodesis.

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