Effect of Opioids vs NSAIDs and Larger vs Smaller Chest Tube Size on Pain Control and Pleurodesis Efficacy Among Patients With Malignant Pleural Effusion

Abstract

isrctn.org Identifier: ISRCTN33288337.

Malignant pleural effusion: from bench to bedside

“…Talc is the most commonly used pleurodesis agent and a meta-analysis supports its use as the sclerosant of choice [4,75]. Even within the context of large randomised trials, pleurodesis success rates remain under 80% and are almost certainly lower in everyday practice [9,10,76,77]. It has been proven that graded preparations (as opposed to small particle talc) should be used to minimise systemic talc particle dissemination and the risk of acute respiratory distress syndrome [78,79].…”

“…Even today, no consensus exists about the optimal size of the chest drain and the time of removal of the tube post-pleurodesis. National guidelines advocate the use of small bore (<14 F) chest drains, but this is now challenged by the results of the largest study to specifically address tube size for MPE in terms of pleurodesis success [10]. Specifically, the TIME1 study showed that smaller chest tubes might be inferior to larger ones in terms of pleurodesis success [10].…”

“…National guidelines advocate the use of small bore (<14 F) chest drains, but this is now challenged by the results of the largest study to specifically address tube size for MPE in terms of pleurodesis success [10]. Specifically, the TIME1 study showed that smaller chest tubes might be inferior to larger ones in terms of pleurodesis success [10]. The results need validation by future randomised trials powered to address the optimum size of chest drain for pleurodesis.…”

“…The use of thoracic ultrasound (TUS) in everyday practice has enhanced the diagnosis of MPE and assisted in the refinement of pleural procedures [8]. Additionally, clinical research in MPE has progressed and high-quality, suitably powered, randomised controlled trials have begun to provide a more robust evidence base for some of the treatment approaches in the field [9,10]. This article attempts to provide a comprehensive overview of current advances in MPE from bench to bedside.…”

The management of benign non-infective pleural effusions

“…The management of malignant pleural effusions has seen considerable progress within the past decade, with a number of randomised controlled trials now informing practice [1][2][3]. This progress, by contrast, has not been mirrored in non-malignant pleural disease, which has an evidence base still formed largely of observational studies.…”