Does Interpleural Bupivacaine Blockade Reduce Arterial Hypoxemia and Pain in Endoscopic Retrograde Cholangiopancreatography? A Prospective Randomized Trial

Abstract

Background and Study Aims: Interpleural blockade with bupivacaine has been used in operations and for the treatment of pain with promising results. Endoscopy may be followed by serious complications associated with the use of intravenous drugs. Drug-induced hypoxemia has an important role in the pathophysiology.

Patients and Methods: A randomized study to assess whether interpleural bupivacaine blockade compared with a standard procedure reduced the risk of hypoxemia and the need of medication in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Other variables studied were its acceptability to patients and morbidity.

Results: Ninety patients were included. Interpleural blockade (n = 43) was followed by minor complications. The blockade itself induced mild hypoxemia in four patients (9 %). Overall, eight patients (27 %) developed hypoxemia. There were correlations between age, drugs given and hypoxemia in the total series and in the two study groups individually. During ERCP eight (19 %) in the blockade group and 16 (34 %) in the standard procedure group developed hypoxemia. During the recovery period the opposite pattern was observed: (26 %) compared with four (9 %) (p = 0.05). Drug requirements did not differ. Procedure-related discomfort did not differ. More patients in the blockade group would prefer another sedative procedure.

Conclusions: Interpleural bupivacaine blockade did not contribute to patients' comfort or safety during ERCP.