CHOLESTASIS AS A SIDE-EFFECT OF BUPIVACAINE

Background and Objectives. Cholestasis has been proposed as a side eff ect of interpleural bupivacaine. Therefore, the effects of various app lication techniques on liver enzymes were studied following ethics com mittee approval and informed patient consent. Methods. Patients follow ing scheduled thoracotomy and laparoscopic cholecystectomy were prospe ctively studied and randomized to the following application techniques of bupivacaine: Thoracic surgery. T0: Control (systemic analgesia onl y: patient-controlled analgesia with opioids; n = 26); T1: Repetitive intercostal blocks (10-20 mL 0.5% bupivacaine, 2-4 times per day for 3 -6 days; n = 17); T2: Interpleural injections via a catheter placed in traoperatively (20 mL 0.25%, 4-6 times per day for 3-6 days, right: n = 25 or left: n = 12). Laparascopic cholecystectomy. Intraperitoneal a pplication (single injection). L0: 50 mL saline (Control) (n = 21). L1 : 50 mL 0.125% bupivacaine (n = 18); L2: 50 mL 0.25% (n = 20). The ser um concentrations of bilirubin, gamma-GT, alkaline phosphatase, leucin e amino peptidase, glutamate oxalacetate transaminase, and glutamate p yruvate transaminase were measured preoperatively and on day 1, 3, and 7 postoperatively. Results. Neither application of plain bupivacaine was associated with significant changes in the postoperative concentra tion of hepatic enzymes. In particular, there was no difference betwee n left- and right-sided interpleural application. Although increases i n hepatic enzyme concentrations were observed in some patients postope ratively, this was similar in the bupivacaine and control groups. Conc lusion. Perioperative interpleural, intercostal, and intraperitoneal a dministration of bupivacaine was not associated with findings indicati ve of cholestasis in the early postoperative course.