Intrapleural block
by Baheti Dwarkadas K, Bakshi Sanjay, Gupta Sanjeeva, Gehdoo Raghbir Singh

Interventional Pain Management: A Practical Approach

by Sanjay Bakshi, Sanjeeva Gupta, Dwarkadas K Baheti, Raghbir Singh P Gehdoo
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This video presents step-wise approach how to perform intrapleural block. Keep patient in sitting position with arm rested on Mayo’s trolley. After preparation of the site with suitable antiseptic solution and identify 8th, 9th and 10th intercostal spaces and outline the surfacing marking of 8th, 9th, and 10th intercostal spaces as shown in this video. Now inject xylocaine 2–3 cc in the 10th intercostal space at midaxillary line. Gently advance 16 gauge Tuohy for about half centimeter into the 10th intercostal spaces and put few drops of normal saline at hub of needle for hanging drop technique. Now slowly advance Tuohy needle further, as the needle enters inter pleural space, the drop get sucked in due to negative pressure. After repeated negative aspiration, inject nonionic, water-soluble dye Omnipaque 3–5 cc and confirm the spread of the dye under fluoroscopy. Now, inject 3–5 cc of Xylocard (preservative-free xylocaine) in to the intrapleural space for pain relief. Gently introduce epidural catheter via epidural needle about 3–5 cm in to the pleural space. Again, inject 2–3 cc Omnipaque in to the epidural catheter and confirm the spread of dye under fluoroscopy in both anterior posterior and lateral view. Under local anesthesia, tunnel the catheter under skin and fix as shown in this video. Now, fix catheter with Tegaderm or Micropore and tape it to the chest wall as shown in this video. Inject tetracycline 8–10 cc is injected through epidural catheter slowly followed by flushing of epidural catheter with injection of bupivacaine 0.25% 1–2 cc. Shift to recovery area and monitor the vital parameters for 2–3 hours.

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