ABSTRACT
BACKGROUND: Pneumothorax is a serious complication of cavitary pulmonary tuberculosis. The aim of this study was to describe clinical futures, to highlight challenges of its management. METHODS: A retrospective multicentric and descriptive study including 65 patients treated for PT (1999-2015) was conducted to figure out clinical futures and its work-up. RESULTS: The mean age was 37.8 years. The sex ratio was 3.6. Smoking history and incarceration were noted respectively in 67.6 and 15.3% of cases. Acute respiratory failure and cachexia were reported in 26.1 and 10.7% of cases. The PT was inaugural in 41.5% of cases. Pyo-pneumothorax was noted in 69.2% of cases. The duration of antituberculous treatment ranged from 6 to 15 months for susceptible TB and was at least 12 months for resistant TB (4 cases). Thoracic drainage was performed in 90.7% patients. Its average length was 47 days. The drain drop was noted in 20% of cases. Bronchopleural fistula was diagnosed in 6 cases and pleural infection in 5 of cases. Surgery treatment was necessary in 6 cases. Mean time to surgery was 171 days. Six patients had pleural decortication associated with pulmonary resection in 4 cases. Persistent chronic PT was noted in 12.6% and chronic respiratory failure in 3% of cases and death in 15.3% of cases. CONCLUSION: The diagnosis of the PT is often easy. Its treatment encounters multiples difficulties. Duration of thoracic drainage and anti-TB treatment are usually long. Surgery is proposed lately.
Subject(s)
Antitubercular Agents/therapeutic use , Drainage/methods , Pneumothorax/therapy , Tuberculosis, Pulmonary/complications , Adult , Chest Tubes/adverse effects , Drainage/adverse effects , Female , Humans , Male , Middle Aged , Pneumothorax/diagnosis , Pneumothorax/etiology , Retrospective Studies , Young AdultABSTRACT
BACKGROUND: We investigated whether intrathecally magnesium sulphate added to morphine and fentanyl reduces patients' postoperative analgesia requirements and prolongs spinal opioid analgesia after thoracotomy. METHODS: In a single-center, prospective, placebo-controlled, double-blind trial, we enrolled 58 adult patients undergoing elective posterolateral thoracotomy. Patients were randomized to receive either 25 µg of fentanyl citrate (0.5 mL)+300 µg of morphine+1.0 mL of preservative-free 0.9% sodium chloride (Group S) or 25 µg of fentanyl citrate (0.5 mL)+300 µg of morphine+50mg of magnesium sulphate 5% (1.0 mL) (Group MgSO(4)) for intrathecal analgesia. Opioid consumption and postoperative pain were assessed for 36 hours. RESULTS: VAS pain scores at rest and on coughing were similar in all groups. The total 36-h intravenous morphine requirements were significantly lower in group MgSO(4) (14 [9.50-26.50] mg vs. 33 [30-41] mg, p<0.001); i.e. 57% less for the group MgSO(4). The total dose of intravenous morphine administered during titration was significantly lower in this group (4 [2-8] mg vs. 8 [6-10] mg, p=0.001). Morphine consumption was significantly lower in the group MgSO(4) at intervals 0-12, 12-24 and 24-36 h. The number of patients requiring titration was significantly lower in group MgSO(4) (68% vs. 96%, p=0.001). There is no difference in opioid side effects. No patient experienced side effects resulting from lumbar puncture, or neurological deficit or signs of systemic magnesium toxicity. CONCLUSION: We found that in patients undergoing pulmonary resection with elective posterolateral thoracotomy, magnesium sulphate (50mg), when added to spinal morphine analgesia reduces postoperative morphine requirements, the number of patients requiring morphine titration without increasing opioid side effects.