Unsuccessful interpleural analgesia in a patient with mesothelioma

Our plain-English summary of Unsuccessful interpleural analgesia in a patient with mesothelioma, by Z.A. Abraham (Anesthesia and Analgesia, 1992).

The study

• Author: Z.A. Abraham
• Journal: Anesthesia and Analgesia
• Published: 1992;75(1):133-5
• Type of article: Case report
• Read it: PubMed · Publisher

In plain English

This case report described one patient, a 63-year-old man with left-sided mesothelioma and chest wall pain, from Yale University School of Medicine. His mesothelioma was attributed to long-term asbestos exposure as a nuclear submarine builder; no fiber type was named. His pain medicine had caused lethargy without significant relief, so he tried interpleural analgesia: a catheter delivering the local anesthetic bupivacaine into the space around the lung. He first noted a significant decrease in chest pain. By about 6 hours the pain had returned, and the fluid around his lung had grown by roughly the amount of drug infused (about 120 mL). The catheter was removed, and he went home 48 hours after placement. Eight weeks later he had thoracic epidural neurolysis with phenol and was relatively pain free 6 months afterward. The author proposed that tumor on the pleural surfaces and walled-off (loculated) fluid kept the anesthetic from reaching the nerves. The author concluded that this method cannot be recommended for mesothelioma chest wall pain, and suggested that a stronger solution, faster infusion, or repeat dose might have worked.

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 63-year-old man with left-sided mesothelioma (a mass in the left pleural space and lung) and chest wall pain, referred to a pain management center; the author was at Yale University School of Medicine, New Haven, Connecticut
• Exposure: Long-term asbestos exposure as a nuclear submarine builder, to which the mesothelioma was attributed; no fiber type or dose given. The treatment studied was interpleural bupivacaine: a 40 mL bolus of 0.25% solution, then 10 mL per hour of 0.25% solution
• Main results:
  • After the catheter was placed and bupivacaine given, the patient noted a significant decrease in chest pain and had no breathing difficulties
  • Pain relief lasted about the first 6 hours
  • A chest x-ray repeated 6 hours later showed a 1-cm increase in the pleural effusion, and the chest wall pain returned with the same characteristics as before
  • The new pleural effusion was estimated at about 120 mL, approximately the same amount as the bupivacaine infused
  • The infusion was stopped and the catheter removed. The patient was discharged 48 hours after the catheter was placed
  • Thoracic epidural neurolysis (6 mL of 6% phenol at T-8 to T-9) was done 8 weeks later, and the patient remained relatively pain free 6 months after it
• The authors' conclusion: The author proposed that tumor involvement of the pleural surfaces and the loculated pleural effusion made the relevant nerves inaccessible to the local anesthetic. The author concluded that interpleural analgesia for the chest wall pain of mesothelioma cannot be recommended
• Limitations the authors state:
  • The author suggested that a more concentrated bupivacaine solution (for example 0.5%), a higher infusion rate, or a repeat bolus dose might have been effective

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma.

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• Is Radiotherapy Useful for Treating Pain in Mesothelioma?: A Phase II Trial — N. MacLeod, A. Chalmers, et al. (2015)
• Re-evaluating the role of palliative radiotherapy in malignant pleural mesothelioma — P. Jenkins, R. Milliner, et al. (2011)
• Clinically important associations of pleurodesis success in malignant pleural effusion: Analysis of the TIME1 data set — R.M. Mercer, J. Macready, et al. (2020)

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