Radiology, Vol 205, 663-668, Copyright © 1997 by Radiological Society of North America
Percutaneous biliary drainage: clinical trial of analgesia with interpleural block
E Therasse, M Choiniere, G Soulez, VL Oliva, P Rousseau, F Fugere, D Boudreault and JR Cusson
Department of Radiology, University of Montreal Medical Center, Quebec, Canada.
PURPOSE: To determine the analgesic efficacy and safety of interpleural
block for percutaneous biliary drainage. MATERIALS AND METHODS: In this
double-blind study, 34 age- and sex-matched patients who were to undergo
percutaneous biliary drainage because of malignant biliary obstruction were
randomly assigned to the true-block group (30 mL 0.5% bupivacaine block) or
placebo-block group; all had access to a patient- controlled analgesia
(fentanyl) pump. Self medication, pain reports, blood pressure, heart rate,
and oxygen saturation were monitored during and until 8 hours after
drainage. The McGill Pain Questionnaire was administered 1 hour after
biliary drainage. RESULTS: Patients in the placebo group self administered
statistically significantly more fentanyl than did patients in the
true-block group (P = .008). Peak pain scores (10-point scale) and McGill
Pain Questionnaire scores were statistically significantly higher for the
placebo group patients (P = .017 and P = .001, respectively). There were no
differences between groups in terms of blood pressure, heart rate, and
oxygen saturation. Two patients had pneumothorax caused by the interpleural
block. CONCLUSION: Interpleural block was effective in decreasing pain and
opioid requirements during and after percutaneous biliary drainage and did
not compromise the cardiopulmonary status of the patient. However, the rate
of pneumothorax was higher than previously reported.
