Letters To The Editor: Letters & Announcements
To the Editor:
Scawn et al. (1) have described an interesting way to block the troublesome shoulder pain after thoracotomy in the presence of effective epidural anesthesia. For the past 10 yr I have used another approach to the same problem.
Intrapleural block, using 20–30 mL of 0.125%–0.25% bupivacaine in adults, has proved effective with no clinical symptoms of ventilatory impairment or systemic toxicity. The technique has been used in thoracotomies as well as nephrectomies and hepatectomies where the diaphragm is lacerated or abraded. In most cases, chest drains were placed for surgical reasons; in these cases, the drains were clamped during injection of bupivacaine and for 5 min thereafter. Where no surgical drains were placed, an intrapleural block is done with a Tuohy needle, leaving an epidural catheter sited intrapleural.
The analgesia from one injection lasts 6–8 h, after which the block may be repeated.
Perhaps because the entire subpleural length of the phrenic nerve is exposed to local anesthetic, the blocks have been uniformly successful in all of the approximately 20 cases in which they were performed.
A.F. David Cole, MD, FRCPC
1. Scawn NDA, Pennefather SH, Soorae A, et al. Ipsilateral shoulder pain after thoracotomy with epidural analgesia: the influence of phrenic nerve infiltration with lidocaine. Anesth Analg 2001; 93: 260–4.