Technique for providing analgesia during percutaneous biliary interventional procedures

AIMS: To evaluate the efficacy of interpleural analgesia during percutaneou s transhepatic biliary procedures. METHOD: With the patient lying in the left lateral decubitus position a rig ht sided interpleural catheter was sited at a chosen point between the 6th and 9th interspaces. Lignocaine was injected to provide a splanchnic and in tercostal nerve block. The technique of interpleural block (IPB) is describ ed, Assessment of the pulse, BP and O-2 saturation during the subsequent bi liary procedure was made. The patient evaluated the maximum degree of pain felt during the biliary procedure according to a four-point pain scale (0-3 ). The nurse and radiologist also gave an objective assessment of the pain score. RESULTS: An IP catheter was successfully placed in 22 patients, one patient having the IPB on two occasions. Siting of the IP catheter failed in three patients. Good analgesia with no requirement for further analgesia or seda tion was achieved in 11 patients on 12 occasions. Seven patients required a dditional small doses of analgesia for mild pain during the biliary procedu re. LPB failed in four patients who required additional analgesia and sedat ion. No complication of the IPB technique occurred in our patient group. CONCLUSION: TPB is a safe and relatively effective method for analgesia dur ing transhepatic percutaneous biliary procedures. (C) 2000 The Royal Colleg e of Radiologists.