Comparison of Pain as Assessed by Visual Analog Scale Using Smaller (12F) Versus Larger (24F) Tubes in Patients with Malignant Pleural Effusion

Abstract

Background: Malignant pleural effusion (MPE) is a frequent complication of advanced malignancy, often requiring pleurodesis for symptomatic relief. Although both small-bore (12F) and large-bore (24F) chest tubes are routinely used, the optimal tube size with respect to patient comfort remains unclear, with conflicting evidence on pain outcomes and limited high-quality randomized data. Objective: To compare post-pleurodesis pain, assessed by visual analog scale (VAS), in patients with malignant pleural effusion undergoing the procedure using smaller (12F) versus larger (24F) chest tubes, and determine whether tube size significantly influences pain perception. Methods: This randomized controlled trial was conducted at the Pulmonology Department, Fatima Jinnah Institute of Chest Diseases, Quetta, from May to November 2024. A total of 384 patients (n = 384) with confirmed MPE, aged 20–70 years, were randomized into two groups (192 per group) based on chest tube size. Patients with coagulopathy, unstable vitals, or known allergies to study drugs were excluded. Povidone-iodine was used for pleurodesis following 12F or 24F tube placement. Pain was assessed using VAS over four days. Ethical approval was obtained (IRB No. FJICD-IRB-2024-05) in compliance with the Helsinki Declaration. Statistical analysis was performed using SPSS v27 with Student’s t-test and stratified analysis. Results: Mean post-pleurodesis VAS scores were 44.16 ± 32.80 mm in the 12F group and 44.34 ± 32.58 mm in the 24F group (p = 0.955), indicating no statistically or clinically significant difference. Subgroup analysis by age and gender showed significant p-values but clinically negligible variations (<2 mm), suggesting uniform analgesic efficacy. Conclusion: Chest tube size does not significantly affect post-pleurodesis pain in patients with malignant pleural effusion when standardized analgesia is provided. Clinicians may base tube size selection on drainage efficacy rather than assumed comfort, enhancing procedural flexibility without compromising patient care.