PubMed · 3942679
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K Kirnø, K Lindell. 1986. Intercostal nerve blockade.. https://doi.org/10.1093/bja%2F58.2.246
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BACKGROUND: Pain, one of the most frequent symptoms of lung cancer, is difficult to control at times, not only because of the many structures involved but also because of the paths through which the pain is conveyed. METHODS: When usual analgesic treatment did not alleviate pain after chemotherapy in a patient with lung adenocarcinoma, long-term interpleural analgesia was begun. A DuPen epidural catheter was inserted between the pleura parietalis and visceralis for the administration of bupivacaine in a bolus regimen every 6 hours. RESULTS: Thoracic pain thus was controlled until the patient died 130 days after placement. CONCLUSIONS: The long-term tunneled interpleural placement of DuPen catheters constitutes an alternative to systemic and spinal treatments for thoracic pain due to cancer.
A high-performance liquid chromatographic method with ultraviolet detection at 210 nm for quantitation of bupivacaine and two of its metabolites from plasma and urine is described. The compounds are extracted into n-hexane-isopropanol (5:1), evaporated and the reconstituted residue injected onto a reversed phase C18 column. Standard curves for all compounds were linear (r2 greater than 0.999) in the range 20-2000 ng/ml, with a limit of detection of 10 ng/ml. The inter-day coefficients of variation ranged between 2.7 and 12.2%. The method was applied to analyse bupivacaine and metabolite concentrations in patients on long-term epidural bupivacaine-fentanyl infusions.