Optimum Anesthesia with Intrapleural Lidocaine during Chemical Pleurodesis with Tetracycline

Sherman, Stanley W; Ravikrishnan, K. P.; Patel, Atulkumar; Seidman, Joel C.

doi:10.1378/chest.93.3.533

Cited by 32 publications

(11 citation statements)

References 12 publications

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“…The higher doses have been shown to increase the number of pain free episodes from 10% to 70% with no appreciable toxicity. 68 Medical and surgical pleurodesis using talc remain effective alternatives to tetracycline pleurodesis. There are no controlled trials comparing talc and tetracycline as sclerosants in the treatment of pneumothorax.…”

Section: Chemical Pleurodesis • Chemical Pleurodesis Can Control Diffmentioning

confidence: 99%

BTS guidelines for the management of spontaneous pneumothorax

Henry

Arnold

Harvey

2003

Thorax

517

319

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Section: Chemical Pleurodesis • Chemical Pleurodesis Can Control Diffmentioning

confidence: 99%

BTS guidelines for the management of spontaneous pneumothorax

Henry

Arnold

Harvey

2003

Thorax

517

319

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“…9 Intercostal, epidural, and interplural blocks have all proven useful in the control of pleuritic pain. 4,5 We consider that paravertebral block is equally effective and has clear advantages. It is simple to perform, it covers a wide region, and it is a unilateral block with the consequent minimal hemodynamic repercussion.…”

Section: Discussionmentioning

confidence: 99%

“…It acts on somatic and sympathetic nerves and, therefore, has similar indications to those for intercostal, interpleural, and epidural blocks. Several investigators have shown the usefulness of these latter blocks in patients with pleuritic pain 4,5 when conventional analgesia with nonopioid analgesics alone or associated with opioids do not provide adequate pain relief. We speculated that TPVB could also be effective in the treatment of pleuritic pain.…”

mentioning

confidence: 99%

Successful management of pleuritic pain with thoracic paravertebral block

Paniagua

2000

Regional Anesthesia and Pain Medicine

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Background and ObjectivesThoracic paravertebral block (TPVB) is a unilateral analgesic technique that has been advocated in both acute and chronic thoracic and abdominal pain. Other blocks such as interpleural and epidural can be effectively used in pleuritic pain. This report illustrates that TPVB could also be effective for this kind of pain.MethodsA 45-year-old man with acute pancreatitis was referred to the critical care unit 11 days after emergency admission with severe left pleural effusion and acute respiratory failure. His medical history revealed hypertension and chronic obstructive pulmonary disease (COPD); in addition, he was a heavy drinker and smoker. A pleuritic pain that only slightly improved with nonopioid analgesics and opioids resulted in the patient’s increasing inability to eliminate bronchial secretions. In an attempt to avoid endotracheal intubation, the pain unit recommended a continuous paravertebral block. The block was performed at T9 on the left side. An initial bolus of 15 mL bupivacaine 0.25% was administered and a continuous infusion, initially at 5 mL/h, was increased up to 10 mL/h to achieve the desired analgesic effect.ResultsAfter the block the verbal analogue scale decreased from 9 to 3, and this level of pain relief was maintained until the end of the treatment 48 hours after the block. The patient improved and was discharged to the ward without the need for endotracheal intubation.ConclusionsThis case report supports the notion that, in practice, the paravertebral block could be an effective and safe alternative to relief of pleuritic pain.

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“…Intrapleural lidocaine has been used to alleviate talc-induced pain, 2,[26][27][28] and some investigators advocate the use of 2 mg to 4 mg of morphine intravenously in combination with lidocaine. 2,26 A dose between 3 mg/kg to 4 mg/kg is probably the optimal intrapleural lidocaine dose.…”

Section: Painmentioning

confidence: 99%

“…2,26 A dose between 3 mg/kg to 4 mg/kg is probably the optimal intrapleural lidocaine dose. 27,28 Researchers suggest waiting five minutes following intrapleural lidocaine administration before giving the sclerosing agent.…”

Section: Painmentioning

confidence: 99%

Talc - Rationale and Use in Malignant Pleural Effusions

Tate

1997

Cancer Control

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Questions relating to drug use, dosing, and related issues in oncology are presented in this regular feature. IntroductionNeoplastic diseases account for approximately 13% of the annual incidence of pleural effusions, and 75% of these effusions are secondary to malignancies of the lungs and breast or lymphoma. 1 The most common pathogenic mechanisms that produce malignant pleural effusions (MPE) are (1) pleural metastasis resulting in increased membrane permeability beyond the capacity of lymphatic drainage, (2) metastatic disease of the lymphatic system resulting in decreased clearance of pleural fluid, (3) bronchial obstruction resulting in reduced pleural pressure, and (4) pericardial metastasis resulting in pleural fluid accumulation. 2 Although systemic chemotherapy is an option for treatment of patients with sensitive tumors, removal of pleural fluid followed by pleurodesis is the primary treatment of MPE. Chemical pleurodesis, also known as sclerosis or obliteration of the pleural space, involves instilling a sclerosing agent bleomycin, doxycycline, or talc -into the pleural space after fluid drainage.2 Tetracycline injection was one of the mainstays of treatment but is no longer available, and nitrogen mustard and quinacrine are now rarely used due to their side effects. 2 ApproachThe goal of management is to alleviate shortness of breath (the most common symptom of MPE), cough, chest pain, and tachypnea. Table 1 summarizes the characteristics of patients who are likely to benefit from chemical pleurodesis.Factors that govern the likelihood that a sclerosing agent will be effective are summarized in Table 2. 2 The intent of intrapleural administration of a sclerosing agent is thought to be the creation of a chemically induced, inflammatory pleuritis that forms adhesions between the parietal and pleural surfaces. This obliterates the pleural space and prevents fluid reaccumulation. 2 Some agents, however, do not cause pleuritis but control effusions. Prior to pleurodesis, the pleural fluid is drained by placing a chest tube, usually via the seventh or eighth intercostal space and into the pleural space connected to a water-sealed suction drainage system. 2 The position of the chest tube, the completeness of the drainage, and the re-expansion of the lung are monitored by chest radiography. [2][3][4] Inadequate drainage of the accumulated fluid may indicate poor tube placement, obstruction of the tube by fibrin or other debris, or loculations. The longer a chest tube is kept in place, the higher the risk of loculation formation. Loculations are pockets of pleural fluid entrapped by membranes of fibrin connecting the parietal and visceral pleura. Effective drainage of entrapped fluid may require the insertion of more than one chest tube. Fibrinolytic agents (eg, streptokinase, urokinase) are used occasionally to solubilize the membranes of fibrin. 2-5

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Optimum Anesthesia with Intrapleural Lidocaine during Chemical Pleurodesis with Tetracycline

Cited by 32 publications

References 12 publications

BTS guidelines for the management of spontaneous pneumothorax

BTS guidelines for the management of spontaneous pneumothorax

Successful management of pleuritic pain with thoracic paravertebral block

Talc - Rationale and Use in Malignant Pleural Effusions

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