Chemical
pleurodesis with
tetracycline is frequently complicated by pleuritic
chest pain. The most promising approach to control
pain is to optimize the use of intrapleural
lidocaine. While administering amounts of intrapleural
lidocaine larger than commonly reported, we attempted to determine a safe and more effective dose, by using a subjective and objective assessment of
pain, by measuring serum concentrations of
lidocaine, and by observing patients for possible toxic effects of
lidocaine. Chemical
pleurodesis with
tetracycline was performed on ten patients receiving an intrapleural dose of 200 mg of
lidocaine (group 1) and on ten patients receiving a 250-mg dose (group 2). A significantly greater number of patients in group 2 were free of
pain following
pleurodesis (7/10 vs 1/10; p = 0.006). Of the 80 serum
lidocaine levels obtained, only one value (6.1 micrograms/ml), in an asymptomatic patient in group 1, exceeded the therapeutic range (1.5 micrograms/ml to 5.5 micrograms/ml). One patient in group 2 experienced transient
numbness of the right hand, a possible side effect of
lidocaine. We conclude that to achieve optimum
anesthesia during chemical
pleurodesis with
tetracycline, it is necessary to use doses of intrapleural
lidocaine large than previously reported. Until the feasibility of a further escalation is demonstrated, 250 mg should be considered the standard dose.