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Size Matters in Chest Tubes-Efficacy of Analgesia and Pleurodesis in Patients With Malignant Pleural Effusion.

Malignant pleural effusions (MPEs) are a common disease process that often results in dyspnea, cough, and chest pain. The treatment goal for patients who experience an MPE is to improve quality of life by minimizing the unpleasant symptoms associated with an effusion. Symptom management can often be achieved through removal of the pleural fluid via thoracocentesis, placement of a chest tube, and using pleurodesis to prevent reaccumulation of fluid in the pleural cavity. Although there is literature to support thoracocentesis, pleurodesis, and more specifically the use of talc in the management of effusions1,2; previously, there were no clear data evaluating the impact of analgesic medications used to treat pleurodesis pain (nonsteroidal anti-inflammatory drugs [NSAIDs] vs opioids) and chest tube size (larger vs smaller) on pain intensity and pleurodesis efficacy. Once talc is instilled into the pleural space to induce pleurodesis, there is an influx of neutrophils, secretion of cytokines, progression of the inflammatory pathway, and fibrosis.3 The activation of the inflammatory pathway is critical for successful pleurodesis. Suppression or impairment of this inflammatory pathway could potentially have an impact on the efficacy of the pleurodesis. There has been a concern that NSAIDs may impair the required JAMA