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Single-Dose Interpleural Versus Intercostal Blockade

Nerve Block Characteristics and Plasma Concentration Profiles After Administration of 0.5% Bupivacaine With Epinephrine

Department of Anesthesiology, University Hospital Leiden, The Netherlands.

Abstract

Analgesic effects and plasma concentration profiles after interpleural (IP) or intercostal (IC) administration of 21 mL of 0.5% bupivacaine with epinephrine (5 µg/mL) were studied in 24 patients (IP group: n = 12; IC group: n = 12) who had undergone cholecystectomy or renal surgery. The number of blocked dermatomes, as assessed by pinprick, was more variable between patients in the IP group (2--9 dermatomes) than in the IC group (6--8 dermatomes). The mean time intervals from the injection to two-dermatome regression and to first need for additional pain medication were 4 h (IP) and 5.5 h (IC) (P < 0.02) and 5.3 h (IP) and 9.8 h (IC) (P = 0.002), respectively. The degree of postoperative pain was evaluated by means of a visual analogue scale. This gradually increased during the first 4 h in the IP group (P < 0.001), but not in the IC group.

Peak bupivacaine concentrations in arterial plasma were approximately 10% higher than those in venous plasma and were attained more rapidly. Peak arterial plasma concentrations after IP injection (2.07 ± 0.53 µg/mL) were significantly higher (P < 0.005) than those after IC administration (1.36 ± 0.48 µg/mL). Peak venous plasma concentrations showed a similar difference (IP: 1.86 ± 0.45 µg/mL; IC: 1.21 ± 0.48 µg/mL; P < 0.005). Peak concentrations were attained later after IP injection both in arterial (IP: 16.3 ± 4.6 min; IC: 8.8 ± 5.4 min; P < 0.002) and venous plasma (IP: 20.0 ± 7.1 min; IC 13.3 ± 6.9 min; P < 0.05). This study demonstrates that single-dose IP blocks provide shorter lasting postoperative pain relief than do IC blocks. In addition, plasma concentrations of bupivacaine are significantly higher after IP than after IC blocks.

Key Words: ANESTHETIC TECHNIQUES, REGIONAL—interpleural, intercostal • ANESTHETICS, LOCAL—bupivacaine • PAIN, POSTOPERATIVE