3.12 Intrapleural Block

Question 1

Indications performing interpleural block

Answer 1

Surgical
1. Breast
mastectomy
Recon
Bx

2. CTS
   Thoracotomy
   Thoracic sympathectomy
   Intercostal chest drain

3. Abdominal
Lap or Open chole
Renal
lithotripsy
Perc nephrostomy
Perc hepatic or biliary draining

Trauma

Chronic Px

Question 2

Trauma

Answer 2

Thoracic chest wall trauma

Caution with haemothorax

Multiple rib fractures
Catheter insertion and continous infusion

Question 3

Interpleural block

Set up

Answer 3

SLIMRAG

1l bag crystalloid
giving set
3 way tap
Prepped and primed

Patient supine
block side arm abducted
hand placed behind head

Skin cleaned
LA infiltrated if awkae

Question 4

Interpleural block

Initial steps

Answer 4

16g Tuohy inserted at entry point
usually 4-8th IC space
Mid-anterior axillary line

Down onto rib
Styler removed
3 way tap giving set saline infusion
attached
end Tuohy needle
Infusion switched on

Question 5

Interpleural block

Answer 5

Tuohy needle walked off rib

No flow through fews
ventilation paused in parlaysed patient

Advancement expiratory in SV

Advance slowly til puncture parietal pleura
- Infusion run freely

3 way tap turned off Syrine LA attached
Negative aspiration
LA Injected

Minimal resistance

Question 6

Interpleural block

Answer 6

Needle removed w. saline running

Typically require large volume for optimal block
20-40ml

Caution Doses

Catheter inserted provide infusion / continuous boli

Question 7

Complications

Technique

Answer 7

1. PTX
2. Intrabronchail injection
3. BPF
4. Catheter misplacement
5. Infection
6. Ipsilateral bronchospasm

Question 8

Complications

LA injection / infusion

Answer 8

1. Systemic LA toxicity
2. Intravascular injection
3. Direct myocardial depression
4. Horner’s syndrome
5. Phrenic N. palsy