Role of Intrapleural Instillation of Mesna for Adhesiolysis in Multiloculated Pleural Effusion and Empyema

The management of Multiloculated pleural effusion and empyema with closed pleural aspiration and intercostal tube drainage fails most of the time due to the presence of thick viscous fluid and multiple septations . We extra plot that MESNA (2-mercaptoethane sulfonate Na) is an agent which is easily available, effective, safe and less expensive and due to its proved action as a mucolytic, chemical dissector and fibrinolytic along with our practical experience, we propose the hypothesis that MESNA can be an intrapleuralfibrinolytic agent which can overcome many limitation of presently available agents. Materials and Methods: It was a Hospital based prospective type of interventional study. Results: The present study was undertaken on 40 clinically and radio logically diagnosed patients of multiloculated pleural effusion (n= 20) and empyema (n=20). Septations were devided in to thin and thick septa as well as few and multiple septations. With instillation of MESNA, there was decrease in multiple septations on Day 1,2, and 3 in both groups and this change in number of septations was found to be statistically significant in both the groups (p<0.001). With instillation of MESNA there was decrease in thick septations on Day 1,2, and 3 in both groups and this change in thickness of septations was found to be statistically significant in both the groups (p<0.001). In Effusion group patient’s, complete resolution was seen in 12 (60%), partial resolution seen in 2 (10%) and 6 (30%) patients still had no resolution. While in empyema patients only 6 (30%) patients had complete resolution, 10 (50%) had partial resolution and 4 (20%) of patients in empyema group had no resolution. This difference in resolution among the two groups was found to be statistically significant (p=0.021). Conclusion: MESNA is a safe drug for intrapleural instillation. Fibrinolytics activity of MESNA is good and it is effective both in multiloculated pleural effusion and empyema. MESNA Can be used as primary intrapleural agent where facility of thoracoscopy and VATS are not available.

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