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Pain control after percutaneous biliary drainage: local infiltration with bupivacaine and epinephrine.

All patients who undergo percutaneous biliary drainage experience pain for several days thereafter. Most patients require parenteral narcotics and some get little relief from these otherwise potent drugs. Besides distressing the patient, pain at the catheter site may cause splinting and atelectasis and may make the patient unwilling to endure a second biliary procedure. We discovered the ability of local anesthetics to control this pain by chance. A patient complained that narcotics made her dysphoric but did not actually relieve the pain. She asked if a local anesthetic would help. We infiltrated the catheter site and achieved complete pain relief.