Tetracycline Pleurodesis for Malignant Pleural Effusion-A Retrospective Review of 20 Cases

• Author(s): Dr Stephen Omirigbe Ogbudu ; Echieh C P ; Nwagboso C I ; Eze J N ; Dien E O
• Paper ID: 1710725
• Page: 1440-1444
• Published Date: 25-09-2025
• Published In: Iconic Research And Engineering Journals
• Publisher: IRE Journals
• e-ISSN: 2456-8880
• Volume/Issue: Volume 9 Issue 3 September-2025

Abstract

INTRODUCTION: OBJECTIVE: Report our experience with the use of tetracycline for pleurodesis in the management of malignant pleural effusion and reasons for failed pleurodesis. METHOD: All patients 18 years and above with malignant pleural effusion were all included in this prospective study except those with cardiac failure and malignant pleural effusion were excluded, Pre-treatment assessment was performed during admission and it include history and physical examination, full blood count, and a pre-drainage posterior anterior and lateral radiograph. A thoracic catheter (sizes24f-32f) was inserted in the mid axillary line through the 5th or 6th intercostal space under local anaesthesia. In some cases, additional intravenous analgesics were administered. The pleural effusion was drained by gravity using under water sealed drainage. Massive pleural effusion was drained gradually. An initial drainage was a controlled drainage with a clamp until patient experience some chest discomfort. Subsequently 5mlskg?¹/hr and temporally suspended if patient experience chest discomfort, but not chest tightness nor difficulty in breathing and cough Daily chest tube outputs were recorded and when drainage fell below 100mls/24hrs, posterior anterior/lateral radiographs were obtained to ensure that the fluid has been sufficiently evacuated, no loculated collections and the lung judged to be fully re-expanded then the patient were eligible for pleurodesis. Clinical response is evaluated according to Paladine’s criteria (FIG 1): Complete response (CR): fluid do not accumulate during the first 30days Partial Response (PR): Recurrence of small amount of effusion which does not need tube drain No response (NR): Recurrence of effusion which needs to be evacuated In malignant empyema thoracis pus is drained till it is serous and culture negative for at least on two occasions. The same principle is applied to patients with Para malignant pleural effusion The solution for pleurodesis consists of 3mg/kg of 2% lidocaine made up to 50mls with normal saline. Tetracycline powder is obtained from tetracycline capsules at 35mg/kg but not exceeding 2g and dissolve in this solution of lidocaine and normal saline, this solution will be drawn into a 50mls syringe and instil into the pleural cavity through the chest tube, the chest tube will be clamp for two hours and unclamp thereafter, If the post sclerotherapy drainage is below 100mls/24hours the chest tube is remove but if drainage is ?5mls/kg pleurodesis is repeated Complicated related to the procedure will be recorded. Posterior anterior and lateral chest radiographs will be done after removal of the chest tube in order to compare with the film that will be done in 30days time. Clinical response will be evaluated according to Paladine’s criteria and adverse reactions will be recorded. RESULTS: Between 1st February 2020 and 28th February, 2023 20 cases of malignant pleural effusions were drained and pleurodeses with tetracycline. The male female ratio was 1:10, the age ranges from 35-77years with an average age of 48.55years. Breast carcinoma account for 80% while ovarian carcinoma account for 10% while, liver cell carcinoma (PLCC), soft tissue sarcoma and thyroid carcinoma account for 5% each. Eighteen patients responded constituting 90% success while two patients had partial respond constituting 10% failure. Right and left malignant effusion account for 50% each. All our patients presented with dyspnoea 100%, eighteen (90%) presented with chest pain and cough and 80% presented with generalised malaise and weight loss (Table 1). Two (10%) with ovarian carcinoma in addition to pleural effusion also presented with massive ascites. Carcinoma of the breast account for massive pleural effusion(2000mls-5000mls), followed by ovarian carcinoma and sarcoma(2600mls-4250mls). There are mostly serous effusions, while PLCC and Thyroid carcinoma account for mild to moderate pleural effusion and haemorrhagic and took longer time to drain(1200mls-3000mls). Dyspnoea was more severe in patients with Ovarian carcinoma may be from the ascites. The Numerical Rating scale for pain (NRS) post pleurodesis range from 5-8/10 and nearly all the patients require additional analgesics for pain management. Patient’s performance status was accessed using Eastern Clinical Oncology Group (ECOG performance status). Two (10%) patients have an ECOG score of 1 while sixteen patients (80%) have an ECOG score of 3 and 2 (10%) with an ECOG score of 2. Metastases with pleural effusion is common in the age range 31-40years followed by 51-60years and same in the age range 41-50years and 71-80years, least in the age range 61-70years. CONCLUSIONS: Tetracycline is effective in pleurodesis of malignant pleural effusion

Keywords

Tetracycline, Pleurodesis, Malignant Pleural Effusion, Malignant Empyema Thoracis, Para Malignant Pleural Effusion, Evacuated and Lung Expansion.

Citations

IRE Journals:
Dr Stephen Omirigbe Ogbudu , Echieh C P , Nwagboso C I , Eze J N , Dien E O "Tetracycline Pleurodesis for Malignant Pleural Effusion-A Retrospective Review of 20 Cases" Iconic Research And Engineering Journals Volume 9 Issue 3 2025 Page 1440-1444

IEEE:
Dr Stephen Omirigbe Ogbudu , Echieh C P , Nwagboso C I , Eze J N , Dien E O "Tetracycline Pleurodesis for Malignant Pleural Effusion-A Retrospective Review of 20 Cases" Iconic Research And Engineering Journals, 9(3)