Effective pain relief with continuous intrapleural bupivacaine after thoracotomy in infants and children

The effect of continuous intrapleural bupivacaine on pain relief after lateral thoracotomy was studied in nine infants (less than or equal to 15 kg body weight) and 11 children (>15 kg body weight). An intrapleural catheter was inserted under direct vision during surgery. After extubation, the patients were transferred to the ICU where vital signs and pain scores were monitored. An intrapleural infusion of bupivacaine 0.25% with adrenaline was given at a loading dose of 0.625 mg . kg(-1) body weight followed by a continuous infusion with a starting rate of 1.25 mg . kg(-1). h(-1). Haemodynamic and respiratory parameters did not differ significantly from control values throughout the study period in either group. The mean infusion rate could be reduced stepwise in both groups to 0.75+/-0.32 mg . kg(-1). h(-1) and 0.73+/-0.38 mg . kg(-1). h(-1) respectively. The pain score indicated a rapid onset of analgesia in both groups and remained low during the study period. The degree of analgesia amongst other factors was position dependent. The lack of any recognizable side effects or complications related to this method has been most encouraging Only one child required a supplementary dose of an opioid. We conclude that continuous intrapleural access has proved to be a safe and suitable route for pain relief in infants and children following thoracotomy.