Comparative evaluation of effects of intrapleural block with adjuvants on analgesia and pulmonary function after intercostal drainage: A pilot study
Journal Title: Medical Journal Armed Forces - Year 2019, Vol 75, Issue 2
Abstract
Background: Inter-costal chest drain (ICD) used for varied thoracic pathologies causes continuous pain and irritation of the pleura, which limits respiratory efforts and impairs ventilatory function. Intrapleural block deposits local anaesthetic between the layers of pleura and may improve ventilatory function especially in non surgical patients. Methods: Twenty eight ASA I-III patients treated with ICD, who could perform incentive spirometry, were included for study. They were randomized to 'Group C' (control group); 'Group B' (Bupivacaine); 'Group M' (Bupivacaine + Morphine) and 'Group D' (Bupivacaine + Dexmedetomidine). The drugs were administered via the ICD itself and clamped thereafter for 15 min. The success of the block was assessed by time for first analgesic demand, maximum inspiratory volume generated and Numerical Rating Scale score for pain; by patients. Results: Effective analgesia was observed in Group B, M and D. Addition of an adjuvant significantly prolonged time for rescue analgesic demand. Patients who received local anaesthetic alone or with an adjuvant had significantly improved maximal inspiratory volume and required lesser rescue analgesics. No significant complications were observed in any group. Pain relief in post-surgical patients using intraplural block is masked by systemic analgesics. However its application in patients with ICD for non surgical indications was explored in this study and was found to improve patient comfort and ventilation. Conclusion: Intra-pleural blockade is safe and effective in relieving the constant pleural irritation and pain of ICD, thus enabling the patient to improve ventilatory effort and faster recovery of respiratory function.
Authors and Affiliations
R. N. Verma
Keywords
Related Articles
- EP ID EP672316
- DOI 10.1016/j.mjafi.2018.03.004
- Views 63
- Downloads 0
Rejected but not dejected: Dealing with an unfavourable decision on a scientific manuscript
Unfavourable decisions and rejections on submitted manuscripts are not uncommon in scholarly publications. Rejection in a particular journal need not be viewed as end of all hopes for aspiring authors. Substantial number...
Tuberculosis diagnosis in resource limited settings
The scourge of tuberculosis (TB), it being first documented in India and China some 3300 and 2300 years ago, respectively, continues globally.1 Towards the common aim of ending the global tuberculosis epidemic, the End T...
Cutaneous myiasis: Think beyond furunculosis
Background: Cutaneous myiasis is the infestation of the skin by larvae (maggots) of the order Diptera (two winged). Being an imported and sporadic illness, furuncular myiasis often poses a diagnostic challenge to the tre...
Prehospital shock index, modified shock index, and pulse pressure heart rate ratio as predictors of massive blood transfusions in modern warfare injuries: A retrospective analysis
Background: Massive hemorrhage is the leading preventable cause of death in modern warfare injuries. Early and accurate detection of source of hemorrhage and massive blood transfusions remain the mainstay of management i...
A case of adenocarcinoma in a tail gut cyst and review of literature
The tail gut cysts (TGC) are extremely rare benign congenital lesions arising from the persistent remnants of postanal gut and occur in retrorectal/presacral region.1 In these as such rare benign lesions, malignant trans...