Abstract
Introduction: Chemical pleurodesis is used to treat malignant pleural effusion (MPE). Injection of sclerosing agents into the pleural cavity leads to inflammation and adhesion of pleural layers. Adequate analgesia is mandatory during the procedure, which may be based on the WHO three-step analgesic ladder for cancer pain. However, several experimental studies have reported a negative influence of NSAIDs on chemical pleurodesis, as they impede pro-inflammatory processes.
Aims and Objectives: The aim was to retrospectively evaluate the influence of NSAIDs on the efficacy of chemical pleurodesis in MPE.
Methods: 120 patients (52 males, 68 females) with MPE undergoing chemical pleurodesis were retrospectively analysed. Clinical, pathological and treatment-related factors were ascertained. Failure of pleurodesis was defined as ipsilateral recurring MPE necessitating re-drainage and/or an MPE exceeding the hilus.
Results: During a mean follow-up period of 7.9 months, 25.8% of patients developed a recurrent MPE (n=31). The peri-interventional use of NSAIDs did not increase risk for failure of pleurodesis (univariate; p=0.133). Post-interventional administration of chemotherapy was the only independent factor reducing risk for recurrent MPE (multivariate; HR:0.339, 95%CI: 0.121-0.948; p=0.039).
Conclusion: According to this analysis, NSAIDs as part of the standard WHO three-step analgesic ladder do not impair the efficacy of chemical pleurodesis. To maintain freedom from pain, administration of NSAIDs should not be discontinued or withheld during pleurodesis in cancer patients.
- Copyright ©the authors 2016