Intrabronchial injection, an unusual complication of interpleural analgesia

Our plain-English summary of Intrabronchial injection, an unusual complication of interpleural analgesia, by D. Dutta, P.A. Hardy (British Journal of Anaesthesia, 1995).

The study

• Authors: D. Dutta, P.A. Hardy
• Journal: British Journal of Anaesthesia
• Published: 1995;74(1):98-9
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This case report, by anaesthetists at Gloucestershire Royal Hospital, UK, described one patient: a 74-year-old woman with mesothelioma of the left pleura. The article does not mention asbestos. The patient's left chest pain had responded poorly to oral morphine 250 mg daily, so an interpleural phenol block was proposed. This is an injection into the space between the lung and the chest wall to block pain nerves. After X-ray screening showed no apparent reason not to proceed, a needle was inserted below the eighth rib and a catheter was passed in. During a test injection of local anaesthetic mixed with contrast dye, the patient coughed slightly and the X-ray showed dye in the airways. The catheter was removed and the procedure abandoned. The patient recovered uneventfully with no collapsed lung. The pain was later treated by cervical cordotomy without complications. The authors presumed that pleural disease, not detected on screening, had kept the lung from collapsing and let the catheter enter it. They suggested that interpleural injection is contraindicated in patients with suspected pleural adhesions caused by past or present pleural disease.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: one 74-year-old woman with mesothelioma of the left pleura in the costo-diaphragmatic angle, referred to a pain clinic (authors at Gloucestershire Royal Hospital, UK)
• Exposure: Not reported. The article does not mention asbestos or any fiber exposure. It concerns a pain-relief procedure (interpleural block) in a patient with mesothelioma.
• Main results:
  • The patient's pain around the left side of the chest had responded poorly to oral morphine 250 mg daily, and an interpleural phenol block was proposed.
  • A 16-gauge needle was inserted below the eighth rib, and a catheter was inserted with ease to 6 cm.
  • During the test injection, which contained contrast dye, the patient gave a slight cough. The X-ray showed the dye in the airways (a contrast bronchogram), and the procedure was abandoned.
  • The patient recovered uneventfully with no pneumothorax (collapsed lung).
  • The pain was later treated by percutaneous cervical cordotomy, which produced pain relief without complications.
  • The authors presumed that the lung did not collapse because of the pleural disease process, which screening had not detected.
• The authors' conclusion: The authors suggested that interpleural injection is contraindicated in patients with suspected pleural adhesions caused by past or present pleural disease. They recommended caution if a patient coughs during the procedure, because it may indicate bronchial rather than pleural irritation. They also recommended X-ray screening during major nerve blocks, particularly with neurolytic agents.
• Limitations the authors state:
  • The authors noted that the pleural disease was not detectable despite careful X-ray screening, and that it is not clear how accurate radiography is in diagnosing pleural fibrosis.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Related studies

• Unsuccessful interpleural analgesia in a patient with mesothelioma — Z.A. Abraham (1992)
• Subcutaneous seeding after ultrasound-guided placement of intrapleural catheter. An unusual complication of the intracavitary palliative treatment of pleural mesothelioma — S. Sartori, I. Nielsen, et al. (1999)
• Palliation of malignant ascites with a Tenckhoff catheter — D.A. Lomas, P.J. Wallis, et al. (1989)
• Cordotomy in mesothelioma-related pain: a systematic review — B.D. France, R.A. Lewis, et al. (2014)
• Re-evaluating the role of palliative radiotherapy in malignant pleural mesothelioma — P. Jenkins, R. Milliner, et al. (2011)
• The safety of medical thoracoscopy in a group at high risk for complications — M. Metintas, G. Ak, et al. (2013)

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