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The interpleural analgesic technique was first described by Reiestad et al for the treatment of acute postoperative pain. It is believed that this technique enables the spread of injected anesthetics to multiple intercostal nerves using a single interpleural injection site. This activity describes the indications, contraindications, and complications of interpleural analagsia and highlights the role of the interprofessional team in the management of postoperative thoracic pain. Objectives: Identify the technique involved in providing interpleural analgesia. Describe the indications for interpleural analgesia. Review the complications of interpleural analgesia. Explain the importance of optimizing care coordination among interprofessional team members to improve analgesia for patients undergoing thoracic surgery. Access free multiple choice questions on this topic.

The interpleural analgesic technique was first described by Reiestad et al. for the treatment of acute postoperative pain.[1]. This technique is believed to enable the spread of injected medication to reach multiple intercostal nerves using a single interpleural injection site. Stromskag and colleagues suggest that after the medication is injected into the interpleural space, it spreads to the intercostal nerves in a retrograde fashion.[2] Therefore, the technique of interpleural analgesia is best suited for thoracic and abdominal pain. When used appropriately, this analgesic modality improves pain control, reduces opioid consumption, and in specific situations may even improve pulmonary function.[3]

The most common complication with the interpleural block is pneumothorax. A retrospective review of 703 procedures found that the incidence of pneumothorax may be as high as 2%.[6][7] However, techniques that avoid the entrainment of air into the intrapleural space may reduce the incidence of pneumothorax when performing the interpleural regional anesthetic. As with any procedure involving the use of local anesthetic, the interpleural block carries the risk of local anesthetic toxicity, especially when large volumes or doses are required for effective analgesia. Additionally, given the proximity of the phrenic nerve and upper thoracic sympathetic ganglia, interpleural analgesia may result in hemidiaphragm paralysis or Horner syndrome. The following is a list of other potential complications: Bleeding or hemothorax Local infection Catheter migration, misplacement, or failed block Pleural Effusion Bronchial trauma or formation of a bronchopleural fistula

Acute pain in the chest and thoracic region that often results from local trauma or surgical procedures may result in significant morbidity and mortality.[8],[9] Poor outcomes in these patients are often associated with increased opioid consumption and diminished pulmonary function.[8][9] The use of regional anesthetic techniques improves both pain control and pulmonary function. These techniques include thoracic epidural, thoracic paravertebral, erector spinae, serratus plane, and intercostal blocks. Interpleural analgesia is another regional anesthetic modality that is beneficial in the treatment of thoracic and upper abdominal pain. Although concerns for pneumothorax and local anesthetic toxicity have limited the use of interpleural analgesia, it remains a safe and effective modality that has few complications and contraindications.[6],[7] Anesthesiologists are often consulted to manage interpleural analgesia for acute pain. Coordination between the consultant and the consulting physician is important in the management of these patients. Cardiothoracic or trauma surgeons may need to be involved in the management of these patients if complications from the procedure have developed. Additionally, the radiologist may be able to provide further insight into the pathology that is causing the pain and determine if complications occur, for example, pneumothorax, and hemothorax, among others. Nurses also play a crucial role in routinely monitoring these patients for acute changes in clinical condition, assessing the adequacy of pain control, and observing the development of complications from interpleural analgesia. Nonetheless, the management of interpleural analgesia requires impeccable communication between all involved clinical personnel, including physicians, nurses, and pharmacists.

Anesthesiologists are often consulted to manage interpleural analgesia for acute pain. Coordination between the consultant and the consulting physician is important in the management of these patients. Cardiothoracic or trauma surgeons may need to be involved in the management of these patients if complications from the procedure have developed. Additionally, the radiologist may be able to provide further insight into the pathology that is causing the pain and determine if complications occur, for example, pneumothorax, and hemothorax, among others. Nurses also play a crucial role in routinely monitoring these patients for acute changes in clinical condition, assessing the adequacy of pain control, and observing the development of complications from interpleural analgesia. Nonetheless, the management of interpleural analgesia requires impeccable communication between all involved clinical personnel, including physicians, nurses, and pharmacists. After a comprehensive review of current literature, the American Society of Regional Anesthesia and Pain Medicine, the American Society of Anesthesiologists, and the American Pain Society established a clinical practice guideline for the management of postoperative pain. The guideline did not recommend the use of interpleural analgesia for the management of pain after thoracic surgery.[10] The current guideline advises against interpleural analgesia in this setting due to the inconsistent data showing benefits and the potential for systemic local anesthetic toxicity. In contrast, a review of pain management in thoracic trauma found interpleural analgesia to be a reasonable option for pain control, especially when other modalities such as the thoracic epidural or paravertebral are contraindicated.[8]