EFFECT OF INTERPLEURAL ADMINISTRATION OF BUPIVACAINE OR LIDOCAINE ON PAIN AND MORPHINE REQUIREMENT AFTER ESOPHAGECTOMY WITH THORACOTOMY - ARANDOMIZED, DOUBLE-BLIND AND CONTROLLED-STUDY

The purpose of the present study was to investigate the efficacy of in terpleural (IP) analgesia with bupivacaine or lidocaine after esophage al surgery and to measure the plasma concentrations of bupivacaine and lidocaine after intermittent IP administrations. Two IP catheters wer e inserted percutaneously in the seventh intercostal space during oper ation. Patients in the bupivacaine group (Gr B) received 1 mg/kg of 0. 5% bupivacaine with epinephrine 1:200000 in 20 mL of saline 0.9%, pati ents in the lidocaine group (Gr L) received 3 mg/kg of 2% lidocaine wi th epinephrine in 20 mL of saline 0.9%, and patients in the placebo gr oup (Gr P) received 20 mL of saline 0.9% every 4 h during 2 days. Pain was assessed by visual analog scale (VAS) every 4 h at rest (VASR), a fter a deep breath or cough (VASC), at the thoracotomy (VAST), and at the laparotomy (VASL). Morphine consumption using a patient-controlled analgesia (PCA) device was recorded. There was no significant differe nce in the mean VASR, VASC, and VASL scores among the three groups. VA ST scores were significantly lower in Gr B at 12, 16, 28, and 32 h whe n compared with Gr P and Gr L (P < 0.05). There was no statistical dif ference in mean VAST between Gr L and Gr P. Total consumption of morph ine was lower in Gr B than in Gr P and Gr L (41.2 +/- 13 mg vs 66.1 +/ - 21 mg in Gr P (P < 0.02) and 75.5 +/- 27 mg in Gr L (P < 0.01)), but were similar in Gr L when compared with Gr P. No patient had any symp toms suggestive of local anesthetic toxicity despite high peak plasma concentration (maximum 5.48 mu g/mL and 3.91 mu g/mL for lidocaine and bupivacaine respectively). We conclude that 1) IP analgesia with bupi vacaine after esophagectomy reduced morphine requirements due to a dec rease in the thoracic pain in comparison to a placebo; 2) IP analgesia with lidocaine was ineffective; and 3) if VAS values in the range 0-3 cm represent adequate analgesia, morphine administration by PCA was n ot sufficient even in association with bupivacaine IP analgesia.