Pain management

Shallow breathing during first day following transthoracic angerior spine surgery can lead to atelectasis, pulmonary collapse and hypoxia, which may continue for some days. Effective postoperative analgesia and physiotherapy can modify this sequence.The purpose of the study was to compare effects of interpleural analgesia (IPA) with bu ivacaine against intravenous narcotics and nonopioids on pain, si c r e effects, bleeding and respiratory function. Methods. This study included 32 patients, average age 14,7 years with idiopathic thoracic scoliosis with preoperative Cobb angle less than 70 degrees, who had surgically correction of scoliosis of 52% with ventral derotative spondylodesis by anterior transthoracic spine aprouch. Interpleurnl catheters were sutured to parietal pleura and lateral thoracic wall tip locations by surgeon at the time of wound closure. The patients received of 20 ml0,25% bupivacaine, continued every 5 to 8 hours postoperatively and IPA removed on the fourth postoperative day.The chest tube was clamped for 15 minutes at each injection. The second group of 20 patients without interpleural catheter received only narcotics and nonopioids.The Pa02 values were calculated in percentage determined by Sorbini, (1 .Respiration, 1968,3). Results. There was a significant pain reduction (72%, P>0,05) in study group as compared to control group for the first 3 days postoperatively. A general increase of Pa02 in correlation of haemoglobin and haematocrit (P>U,05) after surgery were from preoperative 81% to first postop.day o n 94%. There was a statistically significant decrease in incidence of nausea and vomiting (P<0,05) Concluckon. The interpleural analgesia with clamping of chest tube can achieve good pain relieve and physiotherapy. Changes in arterial PO2 is useful indices of alveolar function in surgically treated patients with thoracic ficoliosis. (2.Respiration.1992.327)