Local Anesthetics delivered through Pleural Drainages improve Pain and Lung Function after Cardiac Surgery
23 April 2015
09 June 2015
03 September 2015 (eFirst)
Objective Pleural tubes after coronary artery bypass graft (CABG) surgery usually cause pain resulting interalia in an impact of postoperative breathing. Therefore, the influence of intrapleural lidocaine application through special double-lumen chest tubes with respect to pain relief and lung function was investigated and compared with placebo.
Methods In this study, 40 patients who underwent CABG got intrapleural injection either with 2% lidocaine (n = 20) or placebo (0.9% saline solution) (n = 20) on the first 2 days after surgery. Pain was measured by pain intensity numeric rating scale (NRS) (0 = no pain; 10 = the most intense pain) and lung function by portable spirometer.
Results On the first postoperative day (POD1), mean pain reduction was NRS 1.9 for the lidocaine group with an improvement of the forced expiratory volume in 1 second (FEV1) of 0.51 L. Similar results were shown on the second postoperative day (POD2) with a decreased pain level of mean NRS 1.65 and an FEV1 improvement of 0.26 L. In comparison, results of the placebo group showed no significant pain reduction, neither on the POD1 (NRS 0.35; p = 0.429) nor on the POD2 (NRS 0.55; p = 0.159). Also, there was no significant influence of FEV1 after placebo on the POD1 (FEV1 = 0.048 L; p = 0.70) or on the POD2 (FEV1 = 0.0135 L; p = 0.925).
Conclusion Intrapleural application of lidocaine is a safe and feasible method to reduce drainage-related pain and improving lung function after CABG.
- 1 Payne M, Magovern Jr GJ, Benckart DH , et al. Left pleural effusion after coronary artery bypass decreases with a supplemental pleural drain. Ann Thorac Surg 2002; 73 (1) 149-152
- 2 Matheus GB, Dragosavac D, Trevisan P, Costa CE, Lopes MM, Ribeiro GC. Inspiratory muscle training improves tidal volume and vital capacity after CABG surgery. Rev Bras Cir Cardiovasc 2012; 27 (3) 362-369
- 3 Sasseron AB, Figueiredo LC, Trova K , et al. Does the pain disturb the respiratory function after open heart surgery?. Rev Bras Cir Cardiovasc 2009; 24 (4) 490-496
- 4 Brockmeier V, Moen H, Karlsson BR, Fjeld NB, Reiestad F, Steen PA. Interpleural or thoracic epidural analgesia for pain after thoracotomy. A double blind study. Acta Anaesthesiol Scand 1994; 38 (4) 317-321
- 5 Richardson J, Sabanathan S, Mearns AJ, Shah RD, Goulden C. A prospective, randomized comparison of interpleural and paravertebral analgesia in thoracic surgery. Br J Anaesth 1995; 75 (4) 405-408
- 6 Scott J, Huskisson EC. Graphic representation of pain. Pain 1976; 2 (2) 175-184
- 7 Aktories K, Förstermann U, Hofmann F. Allgemeine und Spezielle Pharmakologie und Toxikologie. 12. Auflage. Muenchen: Elsevier; 2004
- 8 Elia N, Lysakowski C, Tramèr MR. Does multimodal analgesia with acetaminophen, nonsteroidal antiinflammatory drugs, or selective cyclooxygenase-2 inhibitors and patient-controlled analgesia morphine offer advantages over morphine alone? Meta-analyses of randomized trials. Anesthesiology 2005; 103 (6) 1296-1304
- 9 Varela G, Jiménez MF, Novoa N, Aranda JL. Estimating hospital costs attributable to prolonged air leak in pulmonary lobectomy. Eur J Cardiothorac Surg 2005; 27 (2) 329-333
- 10 Puntillo KA. Effects of interpleural bupivacaine on pleural chest tube removal pain: a randomized controlled trial. Am J Crit Care 1996; 5 (2) 102-108
- 11 Demmy TL, Nwogu C, Solan P, Yendamuri S, Wilding G, DeLeon O. Chest tube-delivered bupivacaine improves pain and decreases opioid use after thoracoscopy. Ann Thorac Surg 2009; 87 (4) 1040-1046 , discussion 1046–1047
- 12 Ferguson MK. Difficult Decisions in Thoracic Surgery. An Evidence-Based Approach. Berlin, Heidelberg, New York: Springer; 2011: 155-159
- 13 Symreng T, Gomez MN, Rossi N. Intrapleural bupivacaine v saline after thoracotomy—effects on pain and lung function—a double-blind study. J Cardiothorac Anesth 1989; 3 (2) 144-149
- 14 VadeBoncouer TR, Riegler FX, Gautt RS, Weinberg GL. A randomized, double-blind comparison of the effects of interpleural bupivacaine and saline on morphine requirements and pulmonary function after cholecystectomy. Anesthesiology 1989; 71 (3) 339-343
- 15 Kambam JR, Hammon J, Parris WC, Lupinetti FM. Intrapleural analgesia for post-thoracotomy pain and blood levels of bupivacaine following intrapleural injection. Can J Anaesth 1989; 36 (2) 106-109
- 16 Strömskag KE, Reiestad F, Holmqvist ELO, Ogenstad S. Intrapleural administration of 0.25%, 0.375%, and 0.5% bupivacaine with epinephrine after cholecystectomy. Anesth Analg 1988; 67 (5) 430-434
- 17 Silomon M, Claus T, Huwer H, Biedler A, Larsen R, Molter G. Interpleural analgesia does not influence postthoracotomy pain. Anesth Analg 2000; 91 (1) 44-50
- 18 Welte M, Haimerl E, Groh J , et al. Effect of interpleural morphine on postoperative pain and pulmonary function after thoracotomy. Br J Anaesth 1992; 69 (6) 637-639
- 19 Kaukinen S, Kaukinen L, Kataja J, Kärkkäinen S, Heikkinen A. Interpleural analgesia for postoperative pain relief in renal surgery patients. Scand J Urol Nephrol 1994; 28 (1) 39-43
- 20 Schneider RF, Villamena PC, Harvey J, Surick BG, Surick IW, Beattie EJ. Lack of efficacy of intrapleural bupivacaine for postoperative analgesia following thoracotomy. Chest 1993; 103 (2) 414-416
- 21 Elman A, Debaene B, Magny-Metrot C, Murciano G. Interpleural analgesia with bupivacaine following thoracotomy: ineffective results of a controlled study and pharmacokinetics. J Clin Anesth 1993; 5 (2) 118-121
- 22 François T, Blanloeil Y, Pillet F , et al. Effect of interpleural administration of bupivacaine or lidocaine on pain and morphine requirement after esophagectomy with thoracotomy: a randomized, double-blind and controlled study. Anesth Analg 1995; 80 (4) 718-723
- 23 Raffin L, Fletcher D, Sperandio M , et al. Interpleural infusion of 2% lidocaine with 1:200,000 epinephrine for postthoracotomy analgesia. Anesth Analg 1994; 79 (2) 328-334
- 24 Katz J, Jackson M, Kavanagh BP, Sandler AN. Acute pain after thoracic surgery predicts long-term post-thoracotomy pain. Clin J Pain 1996; 12 (1) 50-55