Is there a bilateral block of the thoracic sympathetic chain after unilateral intrapleural analgesia?

Abstract

This study was designed to ascertain, by telethermography and clinical observation, the effect of injecting anesthetic solutions into the intrapleural space on thoracic sympathetic chains and splanchnic nerves. We studied 15 patients with neoplastic (n = 8) or benign (n = 7) pain, divided into three groups of 5 patients each. The first group received 20 mL of bupivacaine 0.25% in the intrapleural space, the second received 20 mL of bupivacaine 0.5%, and the third received 20 mL of isotonic sodium chloride solution. Each patient was examined telethermographically 30, 60, 90, and 120 min after the blockade. Visceral pain intensity was measured in eight patients using a visual analog scale. Patients receiving bupivacaine had a uniform bilateral increase of cutaneous temperature (+2 degrees C). In those with diffuse visceral pain, the mean value of the pain score decreased from 82 +/- 10 mm at the time of injection to 16 +/- 5 at 120 min. We conclude that intrapleural bupivacaine 0.25% and 0.5% results in bilateral blockade of the thoracic sympathetic chain and also of the splanchnic nerves, which pass in front of the spinal column between the two thoracic sympathetic chains. Our data indicate that intrapleural analgesia can be used in the treatment of not only unilateral visceral and somatic pain, but also diffuse abdominal visceral pain. The bilateral increase of the cutaneous temperature of the trunk (measured telethermographically) and the reduction of the diffuse visceral pain suggest a bilateral block of the sympathetic chain and of the splanchnic nerves.

Implications: We subjected 10 patients to monolateral intrapleural analgesia. Five other patients served as controls. The bilateral increase of the cutaneous temperature of the trunk (measured telethermographically) and the reduction of the diffuse visceral pain suggest a bilateral block of the sympathetic chain and of the splanchnic nerves. Our data indicate that intrapleural analgesia can be used in the treatment of not only unilateral visceral and somatic pain, but also diffuse abdominal visceral pain.