Original Article

PLEURODREN ®


Development and Clinical Application Oriane Lima; Alfredo Duarte; Omar Mourad; Claudio Laurindo; Carlos Eduardo T. Lima e Renato Lacerda.
Thoracic Surgery Division - Hospital Universitario Antonio Pedro
Universidade Federal Fluminense
Niterói, Rio de Janeiro

INTRODUÇÃO

   The introduction of a thoracic drain in the pleural cavity is necessary for the drainage of air or fluids pathologically accumulated. The presence of the drain in the interior of the pleural space, however soft the material from which it is made, remains continously in attriction with the internal surface of the parietal pleura. Being the parietal pleura extremely endowed with sensitive neural terminals, the ensued pleuritic pain is extremely important.

We developed a "Thoracic drain with a coupled microperforated injector catheter" (PLEURODREN) to diminish the intensity of post-drainage pain .(Figure 1).


The Thoracic drain with microperforated injector catheter diminishes the intensity of post-drainage pain because it allows the injection of local action anesthetics that are sprinkled through the microperforations of the injector catheter, directly in the internal surface of the parietal pleura, along the points of attrition with the drain. (Figure 2).



Figure 2


PATIENTS AND METHODS

We utilized the PLEURODREN in 54 patients: 24 toracothomies and in 30 pleural drainages. Analgesia was obtained through injection under pressure of fractioned doses of lidocaine (2% xylocaíne, 4 ml every 6 hours) thus sprinkling the anesthetic in the pleural surface.

In the immediate post-operatory period and until the removal of the thoracic drain(s) respiratory function was evaluated in 12 patients, before and after the injection of the anesthetic through the PLEURODREN as a measure to evaluate and gauge functional improvement correlated with decreased pain. The items studied were: Vital Capacity (VC), Forced Expiratory Volume 1s (FEV1) , Maximal Inspiratory Pressure (PiMx) and Maximal Expiratory Pressure (PeMx)

Subjective pain intensity was evaluated according to the analogue scale of Huskisson (1)

RESULTS

In the post-operatory period we observed, for each patient, an improvement of 80% in the intensity of pain following analgesia. Improvement was referred very soon after injection of the anesthetic by the majority of patients and correlated positively with improvement in respiratory function (Table 1).

TABLE 1 - RESPIRATORY FUNCTION FOLLOWING ANALGESIA.
% INCREASE*
VC
39.8
FEV1
21.9
Pi máx
20.3
Pe máx
43.7
*values= mean

COMMENTS

Analgesia is a key element for a well succeeded convalescence following a thoracic surgery. Postoperatory pain is originated from the surgical trauma to the tissues as well as from inflamatory response. Different alternatives are used to treat postoperatory pain. These include(2): the use of narcotics, intercostal blocks, epidural analgesia and the use of anti-inflamatories.

The results with the use of PLEURODREN , accentuated decrease in the intensity of postoperatory pain, qualify its use as an adequate alternative in the treatment of pain following a thoracic procedure.

REFERENCES

    (1)Huskisson EC. Measurement of pain. Lancet 1974;1:1127

    (2)Kavanagh BP, Katz J, Sandler AN. Pain control after thoracic surgery. A review of current techniques. Aanesthesiology 1994;81:737


Oriane Lima. Hospital Universitário Antonio Pedro. Universidade Federal Fluminense. Niterói, Rio de Janeiro.