Intrapleural administration of 0.25%, 0.375%, and 0.5% bupivacaine with epinephrine after cholecystectomy.

Thirty patients who had undergone cholecystectomy (subcostal incision) were randomly allocated to three groups of ten patients each and given intrapleural injections of 20 ml 0.25% (group I), 0.375% (group II), or 0.5% (group III) bupivacaine each with added epinephrine (5 micrograms/ml). Complete pain relief was obtained within 30 minutes in all but one patient in groups I and II. Pain scores (VAS, 0-100 mm) were recorded at regular intervals and did not exceed 20 mm (mean) in any group from 30 minutes up to 4 hours. Median time interval from the intrapleural injection to administration of supplementary analgesics was 4 hours 20 minutes, 6 hours, and 7 hours 45 minutes in groups I, II, and III, respectively. The maximum plasma concentration of bupivacaine (Cmax), 0.62 (+/- 0.25 SD) microgram/ml in group I, 0.82 (+/- 0.40) microgram/ml in group II, and 1.20 (+/- 0.44) microgram/ml in group III, was significantly higher in group III than in the other groups. The time to achieve maximum plasma concentration of bupivacaine (Tmax) was approximately 15 minutes in all groups. No side effects were observed.