The Annals of thoracic surgery
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Randomized Controlled Trial Clinical Trial
Continuous intercostal analgesia with 0.5% bupivacaine after thoracotomy: a randomized study.
This study was undertaken to evaluate the effectiveness of 0.5% bupivacaine (360 mg/day) as a continuous infusion through an indwelling intercostal catheter inserted intraoperatively in the management of pain after thoracotomy. Eighty-six patients were randomized into three groups: group 1 = intercostal bupivacaine, group 2 = intercostal saline solution, and group 3 = fixed-schedule intramuscular buprenorphine. Supplementary buprenorphine was given as required. ⋯ No between-group differences in pulmonary function were observed. Respiratory complications occurred in no patients in groups 1 and 3 versus 5 in group 2 (p < 0.05). Continuous intercostal bupivacaine provided similar early pain control as compared with fixed-schedule narcotics but induced better analgesia with fewer complications than on-demand narcotics alone (group 2).
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A case of postcardiotomy cardiogenic shock after repair of a congenital ventricular septal defect in a 5-year-old boy is reported. Mechanical circulatory support, instituted with a centrifugal left ventricular assist device, adequately supported the patient for 50 hours until recovery of native left ventricular function occurred. Transesophageal echocardiography proved to be useful in assessment of left ventricular function, allowing for timely institution and withdrawal of mechanical circulatory support.