Injection of Bupivacaine into the Pleural and Mediastinal Drains: A Novel Approach for Decreasing Incident Pain After Cardiac Surgery – Montreal Heart Institute Experience

Abstract

Jennifer Cogan,1 Maud André,2 Gabrielle Ariano-Lortie,2 Anna Nozza,3 Meggie Raymond,1 Antoine Rochon,1 Grisell Vargas-Shaffer4 1Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1C8, Canada; 2Department of Nursing, Montreal Heart Institute, Montreal, QC H1T 1C8, Canada; 3Montreal Health Innovations Coordinating Center, Montreal Heart Institute, Montreal, QC H1Y 3N1, Canada; 4Department of Anesthesiology, Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 3E4, CanadaCorrespondence: Jennifer CoganMontreal Heart Institute, 5000 Belanger, Montreal, Quebec H1T 1C8, CanadaTel [phone]Fax [phone]Email [email protected]: We conducted a chart review of prospectively collected data in order to demonstrate the safety and efficacy of an innovative technique of pleural and mediastinal drain injections.Methods: Patients who had undergone cardiac surgery and who continued to have pain despite the use of a multimodal pain protocol received injections of 20 mL of 0.25% bupivacaine in pleural and/or mediastinal chest drainage tubes.Results: Patients were evaluated for the incidence mediastinitis, osteitis, and deep sternal wound infection as well as the speed and intensity of pain relief. The odds ratio of infection in the infused group was 0.955 (CI = 0.4705, 1.9384). The adjusted mean “decrease in pain” was 4.01 (SEM = 0.15 and 95% CI = 3.78, 4.38), using the 11-point Likert Numerical Rating Scale. The mean adjusted “time to maximum pain relief” was 8.33 minutes (SEM = 0.42 and 95% CI = 7.50, 9.15).Conclusion: This technique is a powerful, safe, and efficient tool in the armamentarium of pain management and its growing use within our institution has provided a substantial benefit in the treatment of early post-operative pain.Keywords: acute pain service, bupivacaine, cardiac surgery, pain management, pleural drain, safety considerations

Keywords

• acute pain service
• bupivacaine
• cardiac surgery
• pain management
• pleural drain
• safety considerations