Korean J Pain.  2019 Apr;32(2):105-112. 10.3344/kjp.2019.32.2.105.

Small dose of naloxone as an adjuvant to bupivacaine in intrapleural infiltration after thoracotomy surgery: a prospective, controlled study

• Amer AF
• Omara AF

• KMID: 2449823
• DOI: http://doi.org/10.3344/kjp.2019.32.2.105

Abstract

BACKGROUND
Severe pain always develops after thoracotomy; intrapleural regional analgesia is used as a simple, safe technique to control it. This study was performed to evaluate whether a small dose of naloxone with local anesthetics prolongs sensory blockade.
METHODS
A prospective, randomized double-blinded controlled study was conducted on 60 patients of American Society of Anesthesiologists statuses I and II, aged 18 to 60 years, scheduled for unilateral thoracotomy surgery. After surgery, patients were randomly divided into two groups: through the intrapleural catheter, group B received 30 ml of 0.5% bupivacaine, while group N received 30 ml of 0.5% bupivacaine with 100 ng of naloxone. Postoperative pain was assessed using the visual analog pain scale (VAS). Time for the first request for rescue analgesia, total amount consumed, and incidence of postoperative complications were also recorded.
RESULTS
The VAS score significantly decreased in group N, at 6 h and 8 h after operation (P < 0.001 for both). At 12 h after injection, the VAS score increased significantly in group N (P < 0.001). The time for the first request of rescue analgesia was significantly longer in group N compared to group B (P < 0.001). The total amount of morphine consumed was significantly lower in group N than in the bupivacaine group (P < 0.001).
CONCLUSIONS
Addition of a small dose of naloxone to bupivacaine in intrapleural regional analgesia significantly prolonged pain relief after thoracotomy and delayed the first request for rescue analgesia, without significant adverse effects.

Keyword

Analgesia; Anesthetics, local; Bupivacaine; Incidence; Intrapleural analgesia; Naloxone; Pain measurement; Pain, postoperative; Thoracotomy

MeSH Terms

Analgesia
Anesthetics, Local
Bupivacaine*
Catheters
Humans
Incidence
Interpleural Analgesia
Morphine
Naloxone*
Pain Measurement
Pain, Postoperative
Postoperative Complications
Prospective Studies*
Thoracotomy*
Anesthetics, Local
Bupivacaine
Morphine
Naloxone

Figure

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  Fig. 1 CONSORT flow chart.

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  Fig. 2 The severity of postoperative pain and onset of analgesia. Interrupted arrow pointed to the time at which visual analogue scale (VAS) significantly increases in naloxone group than bupivacaine group (12 h marked by ◇). Continuous arrow pointed to the time at which VAS significantly increases in bupivacaine group than naloxone group (6 h marked by ☆).

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