Bupivacaine Injections Reduce Pleural and Mediastinal Drain Pain

Injection of bupivacaine rapidly and significantly alleviates postoperative pain associated with pleural and mediastinal drains, according to the results of a study published in the Journal of Pain Research.

Though studies have shown that intrapleural and chest tube-delivered bupivacaine administration successfully decreases pain in various procedures, the safety and efficacy of bupivacaine injections directly into a regular drainage chest tube in the context of cardiac surgery for the treatment of pain caused by the chest tube has not yet been determined.

To establish whether the instillation of 20 mL of 0.25% bupivacaine into pleural and mediastinal drains would decrease pain as well as opioid requirements, a review of hospital data from 4392 patients (28% women) who had undergone cardiac surgery were analyzed. The average age of patients was 66 years.

During the study, 1348 patients continued to experience uncontrolled pain despite the use of the multimodal pain protocol and were therefore treated with an injection of bupivacaine. Pain was assessed on a scale of 0 to 10 every 4 hours.

Additionally, data from 171 patients (29% women) were analyzed to evaluate the rapidity and intensity of the decrease in pain by recording pain scores before injection as well as 5, 10, and 15 minutes after injection. The mean age of these patients was 67 years.

No significant difference in incidence of infection was observed between patients who received drain injections and those who did not (odds ratio [OR], 0.955; 95% CI, 0.4705-1.9384). No adverse cardiac event related to the injection of drains was observed.

The adjusted mean decrease in pain was 4.08 plus or minus 0.15 points (95% CI, 3.78-4.38) in the 15 minutes after injection. The mean adjusted time to maximum pain relief was 8.33 plus or minus 0.42 minutes (95% CI, 7.50-9.15).

The results of this study indicate that the injection of bupivacaine in chest drains after cardiac surgery is an effective and safe method of reducing drain-related pain. No previous study has shown a decrease in pain of this magnitude with an onset this rapid.

Limitations to this study include the inability to eliminate the possibility of a placebo effect as well as the small sample size used for the evaluation of rapidity of pain alleviation.

Reference

Cogan J, André M, Ariano-Lortie G, et al. Injection of bupivacaine into the pleural and mediastinal drains: a novel approach for decreasing incident pain after cardiac surgery – Montreal Heart Institute experience. Published online December 16, 2020. J Pain Res. 2020;13:3409-3413. doi:102147/JPR.S279071