Department of P l asti c and Re c onstru c tive Surgery, Roya l Vi c toria Infirmary, New c ast l e-upon-Tyne, UK.

The use of intrap l eura l (IP) ana l gesia for c ontro l l ing post-operative pain in breast re c onstru c tion is not we l l do c umented. The obje c tive of this study was to assess the va l ue of IP bupiva c aine in those patients undergoing l atissimus dorsi breast re c onstru c tion. Twenty-six patients re c eived a sing l e bupiva c aine IP inje c tion at indu c tion of anesthesia. Eighteen of these patients a l so re c eived a 24-hour postoperative IP infusion. A c ontro l group of 22 patients did not re c eive an IP b l o c k. A l l patients had a c c ess to morphine via patient- c ontro l l ed ana l gesia pumps. The 24-hour morphine requirements were re c orded for ea c h group and the data were ana l yzed by Student t test. Signifi c an c e was taken at the 5% l eve l . The mean morphine requirement in the c ontro l group was 39.2 mg +/- 2.89 mg. This was signifi c ant l y greater than the requirement of the 8 patients who had a sing l e IP inje c tion of bupiva c aine at indu c tion (10.1 mg +/- 2.76 mg), P < 0.001. It was a l so signifi c ant l y greater than that of the 18 patients who re c eived an IP infusion (2.7 mg +/- 1.35 mg), P < 0.0001. The infusion group required signifi c ant l y l ess morphine than the sing l e inje c tion group did, P < 0.02. No c omp l i c ations fo l l owing IP inje c tion were noted in this series. Intrap l eura l ana l gesia is a safe te c hnique and signifi c ant l y redu c es the requirement for postoperative opiate ana l gesia in those undergoing l atissimus dorsi breast re c onstru c tion.

P M ID: 18724122 [Pub M ed - in pro c ess]