Pain control is a major concern in post-thoracotomy patients. The current prospective randomized double-blind study was designed to evaluate the analgesic effects of morphine and fentanyl given interpleurally after posterolateral thoracotomy. Thirty patients undergoing elective posterolateral thoracotomy in a teaching hospital in Tehran were divided into 3 groups with equal number of patients. ...

Abstract Background Thoracic epidural analgesia (TEA) has been the traditional option for post-operative pain management Kausch-Whipple pancreaticoduodenectomy (KWPD) via a ‘reverse L’ incision. An alternative with inter-pleural (IPA) become popular. However, superior form of KWPD regarding analgesic and non-analgesic outcomes is unclear. This study aims to establish if IPA equivalent TEA. Meth...

Intrapleural tissue plasminogen activator (tPA) and deoxyribonuclease (DNase) therapy is being increasingly employed as an alternative to surgical intervention for the treatment of complicated parapneumonic effusions and empyema. Published cases are limited to one randomized control trial and few case reports. No data exist on employing sequential or repeated courses of intrapleural tPA/DNase t...

The toxicity of intrapleural Tice strain Bacillus Calmette-Guérin (BCG) infection was tested in hamsters. Doses above 10(6) colony-forming units caused significant systemic infection, which could be controlled with conventional antituberculosis therapy. Living BCG in the pleural space did not prevent the healing of bronchial or vascular closures after pulmonary resection. Prophylactic intrapleu...

Sir,—We were particularly interested in the findings of Drs Conacher and Kokin's radiological study of paravertebral block [1], but feel that this is potentially misleading. Our observations from a continuing series of 45 cases of paravertebral block contrast significantly with the findings in their small study. Using a modification of Moore's technique we have injected 0.75 % bupivacaine 5 ml,...

INTRODUCTION Intrapleural fibrinolytic enzyme therapy is a potentially surgery-sparing treatment for poorly resolving parapneumonic effusion and empyema. It is safe in the majority of patients, however the most significant risk associated with this treatment is severe bleeding secondary to pleural hemorrhage. Contraindications for intrapleural enzyme therapy are not widely agreed upon and littl...

BACKGROUND The role of intrapleural fibrinolytic agents in the treatment of childhood empyema has not been established. A randomised double blind placebo controlled trial of intrapleural urokinase was performed in children with parapneumonic empyema. METHODS Sixty children (median age 3.3 years) were recruited from 10 centres and randomised to receive either intrapleural urokinase 40 000 unit...