Alioke II1*, Delia IZ2, Aminu MB2, Sufyan I2, Anumenechi N3, Edaigbini SA2 and Etiuma AU4
1Division of Cardiothoracic Surgery, Federal Medical Centre, Abuja, Nigeria
2Division of Cardiothoracic Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
3Division of Cardiothoracic Surgery, National Hospital, Abuja, Nigeria
4Division of Cardiothoracic Surgery, University of Calabar Teaching Hospital, Calabar, Nigeria
Introduction: The presence of malignant pleural effusion signifies an advanced malignancy, and the aim of management is palliative, including palliation of dyspnea. This can be achieved by tube thoracostomy and drainage, with subsequent pleurodesis. Several sclerosants have been used to achieve pleurodesis in malignant pleural effusions, including the use of tetracycline. Autologous blood pleurodesis has commonly been used for spontaneous pneumothorax, but less commonly for malignant pleural effusion. This study sought to compare the efficacy of autologous blood and tetracycline for pleurodesis in patients with malignant pleural effusions presenting to Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria. Materials and Methods: A prospective randomized comparative study of adults with symptomatic malignant pleural effusion requiring drainage, being managed at the Ahmadu Bello University Teaching Hospital (ABUTH), Zaria within the twelve-month study period was conducted. Fifty patients were used for this study and were divided into two groups of 25 each viz.: Patients who received autologous blood pleurodesis, and those who received tetracycline pleurodesis during the study period. The duration between pleurodesis and tube removal, need for repeat pleurodesis, pain score, the incidence of complications, and a 30-day review of a plain chest radiograph [according to the American Thoracic Society/European Respiratory Society (ATS/ERS) consensus statement on the definitions of success or failure of pleurodesis in the management of malignant pleural effusions] were recorded. Results: Autologous blood pleurodesis was associated with significantly reduced pain at 5 min (1.60 vs. 5.04; p-value <0.01), and 6 h (0.04 vs. 1.12; p-value <0.01) after pleurodesis, but not at 24 h (0.20 vs. 0.40; p-value 0.13) after pleurodesis, compared to tetracycline pleurodesis. The mean duration between pleurodesis and removal of chest tube was significantly reduced in those who had autologous blood pleurodesis compared to those who had tetracycline pleurodesis (1.32 vs. 2.40 days: p-value 0.02). The success rate and need for repeat pleurodesis for both pleural sclerosants were comparable to each other with no statistically significant difference. Only one patient who had tetracycline pleurodesis had a fever as a complication. Conclusion: The efficacy of autologous blood as a pleural sclerosant is comparable to tetracycline and only better in terms of reduced pain scores. Autologous blood is thus, a readily available alternative for use for pleurodesis when tetracycline or lignocaine is unavailable or contraindicated.
Malignant pleural effusion; Pleurodesis; Autologous blood; Tetracycline
Alioke II, Delia IZ, Aminu MB, Sufyan I, Anumenechi N, Edaigbini SA, et al. Comparison of the Efficacy of Autologous Blood and Tetracycline for Pleurodesis in Malignant Pleural Effusions in Zaria. Clin Surg. 2021; 6: 3244..