Technique for Providing Analgesia During Percutaneous Biliary Interventional Procedures

AIMS: To evaluate the efficacy of interpleural analgesia during percutaneous transhepatic biliary procedures. METHOD: With the patient lying in the left lateral decubitus position a right sided interpleural catheter was sited at a chosen point between the 6th and 9th interspaces. Lignocaine was injected to provide a splanchnic and intercostal nerve block. The technique of interpleural block (IPB) is described. Assessment of the pulse, BP and O2saturation during the subsequent biliary procedure was made. The patient evaluated the maximum degree of pain felt during the biliary procedure according to a four-point pain scale (0–3). The nurse and radiologist also gave an objective assessment of the pain score. RESULTS: An IP catheter was successfully placed in 22 patients, one patient having the IPB on two occasions. Siting of the IP catheter failed in three patients. Good analgesia with no requirement for further analgesia or sedation was achieved in 11 patients on 12 occasions. Seven patients required additional small doses of analgesia for mild pain during the biliary procedure. IPB failed in four patients who required additional analgesia and sedation. No complication of the IPB technique occurred in our patient group. CONCLUSION: IPB is a safe and relatively effective method for analgesia during transhepatic percutaneous biliary procedures.Razzaq, R. (2000). Clinical Radiology55, 131–135.