Shahab Naqvi, Zameer Rajput, Kamal Saleem, Naseem Riaz.
Continuous Interpleural Bupivacaine versus continuous Intravenous Morphine for Post Thoracotomy Pain.
Pak Armed Forces Med J Jan ;49(2):86-90.

This prospective randomised clinical trial was designed to assess two different means of pain relief after lateral thoracotomy with minimum effect on breathing capacity of patients in ICU. Patients between the age of 15-50 years who had undergone surgery for ligation of patent ductus arteriosus (PDA), coarctation of aorta, close mitral valvotomy and atrial septal defect (ASD) closure via lateral thoracotomy were selected for study. Patients were randomly divided in two groups. IPB (interpleural bupivacaine) group was given interpleural 0.25°r6 bupivacaine @ 15 ml/hour with the help of syringe pump. Intravenous morphine (IVM) group was given morphine infusion with morphine 1 mg/Kg in 50 ml @ 1 ml/hour with the help of syringe pump. Both infusions were started immediately after chest closure. There were no' differences in patient characteristics, extent of surgery, premedication and induction and maintenance of anaesthesia. Respiratory rate, vital capacity, peak expiratory flow rate (PEFR), and PaC02 were assessed at pre-anaesthetic visit and at 5,8 and 24 hours after operation. Pain was recorded on a 5 point visual analog scale, Results show no significant difference in analgesia in both groups, whereas vital capacity, peak expiratory flow rate, respiratory rate and PaC02 were significantly better in IPB as compared to IVM group. It is concluded that continuous interpleural bupivacaine analgesia is safe, provides efficient pain relief after thoracotomy and causes less respiratory depression as compared to parenteral morphine. Better results could be expected if the catheter is placed in paravertebral gutter under direct vision and anchored there with a loose stitch.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com