Current guidelines that advocate the avoidance of NSAIDs and use of small chest tubes in patients with malignant pleural effusion undergoing pleurodesis have been challenged by a group of international experts.
Writing in JAMA the research team including Professor Y.C. Gary Lee from Sir Charles Gairdner Hospital in Perth, Western Australia explained that clinicians traditionally avoided NSAIDs because they were thought to reduce the efficacy of the procedure by suppressing acute inflammation caused by pleurodesis agents.
Their 2 x 2 factorial phase III trial involving 320 patients with malignant pleural effusions requiring pleurodesis aimed to assess the effect of analgesia (NSAID vs opiates) and chest tube size on pain and clinical efficacy of the procedure.
Patients undergoing thoracoscopy (n=206) received a 24F chest tube and were randomised to receive NSAIDs or opioids.
Those not undergoing thoracoscopy were randomised into four groups: 24F chest tube plus opioids; 24F tube plus NSAIDs; 12F tube plus opioids; and 12F tube plus NSAIDs.
Patients prescribed NSAIDs reported similar pain levels to those prescribed opioids but the NSAID group required more rescue analgesia.
The type of painkiller used also appeared to have little effect on the success of the procedure, results showed.