Pain During Thorocentisis ... - 1270779

patrick1945
Posts:19

After surgery, chemo, radiation, my wife has persistent buildup of pleural fluid. This buildup causes pain and shortness of breath.
Several thoracentis have been done, each with serious pain during the draining process. She has about 1 full liter of excess fluid, but, due to the pain, the radiologist can only drain about 300ml.

Can anything be done to reduce the pain during the procedure? I should add that the pain occurs during the draining process, even though the radiologist is doing it slowly and stops several times.

thanks very much.

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Reply # - August 16, 2015, 05:46 AM

catdander
Posts:

Hi Patrick,

I'm so sorry your wife is experiencing such pain. This can be such an awful disease. There was a recent post on the the subject where Dr. West and a patient/nurse responded that may be of help. You can find it here. http://cancergrace.org/topic/pleurx-catheter-severe-pain-after-drainage…

I hope hope she finds relief for this soon. Every bit of comfort we can find for our loved ones the better.

All best,
Janine

Reply # - August 16, 2015, 06:05 AM

patrick1945
Posts: 19

Janine:

Thanks for the link you provided. It was helpful.
A few related questions...hopefully, that's ok.

1. My wife has been very apprehensive and tense during each of her thora. procedures. Would it make sense to have her somewhat sedated (I.e., taking Xanax or something similar) before the procedure.

2. two of the three lobes in her right lung were resected about six months ago. We expected diminished lung capacity, but in the last month, her breathing problems have become quite a bit worse. Her oncologist increased her dosage of Prednisone to 25 mg./day, but that hasn't helped all that much.

So, could the buildup of pleural fluid be the culprit here? during the last thoracentisis the radiologist said that it appeared there was a full liter of excess fluid in the pleural space. He was able to drain only 300 ml. during the procedure due the pain caused during the procedure itself.

Many thanks again,
Pat

Reply # - August 16, 2015, 06:57 AM

catdander
Posts:

Pat,

Absolutely yes, something to calm and relax her and perhaps her muscles may help her psychologically and lessen the pain and physically help relax muscle tension thereby allowing more fluid to be drained. My comment on muscle relaxants is a non pro guess but a question to ask. An antianxiety drug like xanax plus a muscle relaxant may be safe to give together so as more fluid could be taken as possible. Hopefully she's already taking a pain reliever beforehand. Please note my reference to not being a health professional and my statement here is question to ask your doc. Everyone of these drugs is powerful and together would need to be prescribed with careful dosing in mind if it should be done at all. But it's heartening to hear you're looking out for her.

Yes, PEs cause shortness of breath and this scenario could easily be the reason for the shortness of breathe.

I'll ask a doctor to reply though it's probably going to be tomorrow before we hear back.

Best of luck and hopes to you and your wife.

Janine

P.S. I'm sorry it took so long to reply. I promise to be quicker in the future. :)

Reply # - August 16, 2015, 09:22 AM

patrick1945
Posts: 19

Janine:

Thanks for your thorough and helpful reply. No big deal on the delay.

Pat

Reply # - August 17, 2015, 05:11 PM

carrigallen
Posts: 194

It sounds like the procedure is causing pain because of 'trapped lung'. This is when the cancerous effusion creates adhesions that cause the lung to stick in a collapsed position.

When attempts are made to drain the fluid with a thoracentesis procedure, a forceful negative pressure is exerted on the lung but it cannot expand any further. Pain occurs. It is essentially like giving the lung a 'hicky', similiar to how it feels when a strong vacuum is applied to bare skin. Pushing to drain more fluid will only cause more pain.

The mainstay to remedy "trapped lung" is a surgical procedure called pleuroscopy, lysis of adhesions, with pleurodyesis. This is done by a thoracic surgeon. You can talk to your doctor to see if this option is right for her.

Reply # - August 18, 2015, 10:19 AM

patrick1945
Posts: 19

Thanks very much, Dr. Creelan.

Unfortunately, my wife is about at the end of her rope regarding invasive surgeries.

However, what about using an anti anxiety med, i.e., Xanax along with a strong pain reliever before the procedure?

Reply # - August 19, 2015, 11:02 AM

dr walko
Posts: 102

Patrick,

Anxiety is completely understandable in this situation. Drugs like Xanax (alprazolam), Ativan (lorazepam) or Valium (diazepam) are related drugs commonly used to decrease anxiety and are often preferred because they cause a phenomenon called "retrograde amnesia" that helps to disassociate the link between the procedure that causes the anxiety (i.e. the thoracentesis) and the anxiety associated with it. Both Xanax and Ativan have a peak onset time of about 1hr on average and can last for several hours (Ativan longer than Xanax). I think it would be very reasonable to discuss with your wife's physician about her anxiety surrounding the procedure as well as having a good pain regimen in place during and after. A short acting pain medication like Fentanyl may help with the procedure related pain as well.

I am generally not a great fan of "muscle relaxers" as a class of drugs and would try to manage with the above recommendations. Another alternative source, depending on your wife's preferences and what is offered at the cancer center at which she is being treated is some relaxation therapy in the form of massage or something similar. These can teach relaxation and breathing techniques to help with emotional prep for the procedure and be used in combination with anti-anxiety and pain medications.

Best Wishes,
Dr. Walko

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