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Influence of Anti-Inflammatory Drugs in the Experimental Pleurodesis Induced by Silver Nitrate or Talc

Pulmonary Division - Heart Institute (InCor) - University of Sao Paulo, Brazil

PURPOSE: Pleurodesis is frequently considered for the management of recurrent malignant pleural effusions and pneumothorax. A significant percentage of patients who are candidates for pleurodesis may be receiving anti-inflammatory drugs at the time pleurodesis is attempted. We have previously shown in rabbits that the use of corticosteroids decreases the initial inflammatory process and diminishes the efficacy of pleurodesis induced by talc or doxycycline (Am J Respir Crit Care Med 1998,157:1441-44, Chest 2002,121:216-9). The aim of this study was to evaluate the influence of steroidal and nonsteroidal anti-inflammatory drugs in the effectiveness of pleurodesis induced by silver nitrate or talc.

METHODS: Rabbits received intrapleural injection of silver nitrate (SN) 0,5% or talc slurry (TS) 400 mg/kg. The animals were subdivided in groups that received intramuscular injection of metilpredinisolone (Cort) (1mg/Kg/weekly) or Diclofenac (Dicl)(1.2 mg/Kg/daily during the first seven days). After 28 days, the animals were sacrificed and macroscopic analysis for pleural adhesions, atelectasis and hemothorax was done. Statistical analysis: t test.

RESULTS: The pleural adhesions were significantly reduced (*p < 0.05) in the talc group that received anti-inflammatory drugs (TS x TS Cort and TS x TS Dicl).

CONCLUSION: In rabbits, metilprednisolone and diclofenac inhibited the pleurodesis induced by talc. Silver nitrate induced an efficient pleurodesis despite the use of systemic anti-inflammatory drugs.

CLINICAL IMPLICATIONS: If these results can be extrapolated to clinical practice, anti-inflammatory drugs should be avoided with talc pleurodesis. Our results indicate that these drugs may not affect the final result of pleurodesis with silver nitrate.

Pleural adhesions Atelectasis Hemothorax SN 3.2± 1.1 1.9± 1.6 0.8± 1.5 SN+Cort 3.5± 0.6 1.2± 0.8 0.8± 1.5 SN+Dicl 4.0± 0.0 1.2± 0.3 0.7± 1.2 TS 2.2± 0.8* 0.0± 0.0 0.0± 0.0 TS+Cort 1.3± 0.7 0.0± 0.0 0.0± 0.0 TS+Dicl 1.3± 1.1 0.0± 0.0 0.0± 0.0 Data were expressed as mean ± SD

TS vs TS+Cort and TS+Dicl

DISCLOSURE: P.F. Paz, None.