Trying to Make Pleurodesis Less Painful

Management of malignant pleural effusion often includes chest tube placement and pleurodesis — two potentially painful procedures. In an international 2x2 factorial trial in 320 patients, investigators studied whether treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) and use of smaller-bore chest tubes could spare patients discomfort without impeding the effectiveness of pleurodesis. All patients were randomized to either NSAIDs (800-mg ibuprofen 3 times daily) or opiates (10–20-mg morphine 4 times daily) for pain control; 114 also were randomized to 12 French (F) or 24F chest tubes (206 patients required thoracoscopy, which mandated that 24F tubes be placed).

Researchers recorded no difference in pain control between the NSAID an…