Intrapleural administration of 0.5% plain bupivacaine compared to 0.5% epinephrine: a hemodynamic and ventilatory study.

The ventilatory and hemodynamic effects of 20 ml 0.5% intrapleural bupivacaine with and without 5 micrograms/ml epinephrine were studied. Ten patients scheduled for intrapleural block in the treatment of chronic visceral pain had a left-sided intrapleural catheter inserted. In a double-blind, crossover design they received 20 ml 0.5% bupivacaine with and without 5 micrograms/ml epinephrine. Forced vital capacity, vital capacity, and forced expiratory volume in one second were measured before and 30 minutes after the injection. Mean blood pressure, heart rate, and cardiac output were recorded before the injection and at five-minute intervals for 30 minutes. Vital capacity, forced vital capacity, and forced expiratory volume in one second were unchanged in both groups. There were no differences in any of the pulmonary function tests between the groups. When data from both groups are pooled, vital capacity shows a decrease of 7% (p less than 0.05). No changes in heart rate or mean blood pressure were seen in either group. Bupivacaine without epinephrine did not affect the cardiac output, whereas bupivacaine with epinephrine resulted in a rise in cardiac output of 15% at 15 and 20 minutes after the injection. We did not find any major effects of intrapleural injection of 20 ml 0.5% bupivacaine with and without 5 micrograms/ml epinephrine on ventilatory capacity or cardiovascular function in patients treated for chronic visceral pain.