Interpleural Anesthesia

Published on 06/02/2015 by admin

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Last modified 06/02/2015

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34 Interpleural Anesthesia

Perspective

Interpleural anesthesia is a technique developed in an attempt to simplify body wall and visceral anesthesia after upper abdominal or thoracic surgery. Although considerable research has been carried out on the technique, accurate stratification of the risks and benefits of interpleural anesthesia remains elusive, and it is primarily a technique of historical interest.

Patient Selection

Patients undergoing upper abdominal or flank surgery or those recovering from fractured ribs have been most frequently selected for interpleural anesthesia. The appropriate selection of these patients remains ill defined.

Pharmacologic Choice

Most commonly, 20 to 30 mL of local anesthetic solution is injected through the interpleural needle or catheter. The most common local anesthetic concentrations used have been 0.25% to 0.5% bupivacaine or 0.2% to 0.5% ropivacaine.

Placement

Anatomy

The pleural space extends from the apex of the lung to the inferior reflection of the pleura at approximately L1. The pleural space also relates to the posterior and anterior mediastinal structures, as illustrated in Figure 34-1.

Figure 34-1. Interpleural block: anatomy.

Position

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