Spontaneous pneumothorax: chest drain: intrapleural bupivicaine reduced pain during the first 4 hours

Clinical bottom line (level 1b)

  1. Patients with a chest drain for spontaneous pneumothorax who received intrapleural bupivicaine compared with placebo had less pain after the first 2 injections.
  2. There was no clear reduction in the need for parenteral morphine.
Engdahl et al: Acta Anaestiolol Scand 1993; 37 : 149-153
Expires May 2003

The study

Double-blinded ?concealed randomised trial with intention-to-treat
Setting: acute hospital, Sweden

22 patients (aged mean 36, 72% male) with a spontaneous primary pneumothorax treated with a chest drain.
Control Group: (n = 11, 11 analysed): saline
Experimental Group: (n = 11, 11 analysed): bupivicaine 5 mg/ml with epinephrine 5 microgram/ml
All patients had 20G drain inserted into the 4th, 5th or 6th intercostal space in the midaxillary line. Patients received midazolam and local anaesthesia. An epidural catheter was inserted 5-10 cm into the pleural cavity dorsal to the drain in the same intercostal space. Patients received 20 ml interpleural injections at 4 hours, then 8 hourly. The injection was made with the patient in a supine position and after clamping of the chest drain. The drain was declamped after 10 minutes, and the patient allowed to change dposition after 30 minutes. Patients received up to 10 injections.
100% followed for ? days

The evidence

  • Patients given bupivicaine compared with placebo had significantly less pain on a visual analog scale for up to 4 hours.
  • After the first injection differences in pain levels between the 2 groups were only significant after the 2nd and 7th injection for up to 30 minutes.

Comments

  1. The study was too small to show any difference in patient requests for parenteral morphine.

Citation

  1. Engdahl O, Boe J, Sandstedt S, et al: interpleural bupivicaine for analgesia during chest drainage treatment for pneumothorax; a randomized double-blind study. Acta Anaestiolol Scand 1993; 37 : 149-153
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Contributor: Chris Ball, May 2001
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Clinical Question.
Patient spontaneous pneumothorax and chest drain
Intervention or Exposure intrapleural bupivicaine
Comparison saline
Outcome pain